A neoclassical growth model is used to empirically test for the influences of a civil war on steady-state income per capita both at home and in neighboring countries. This model provides the basis for measuring long-run and short-run effects of civil wars on income per capita growth in the host country and its neighbors. Evidence of significant collateral damage on economic growth in neighboring nations is uncovered. In addition, this damage is attributed to country-specific influences rather than to migration, human capital, or investment factors. As the intensity of the measure used to proxy the conflict increases, there are enhanced neighbor spillovers. Moreover, collateral damage from civil wars to growth is more pronounced in the short run.

SummaryPostmortem examination offive institutionalised patients with Down's syndrome (DS) aged 40-66 years showed a complete absence of atheroma, while a similar number of mental defectives without DS were found to have mild or severe atheroma. Previous investigation of risk factors for atheroma in 70 patients with DS and 70 ageand sex-matched mental defectives living in the same institution showed significantly lower systolic and diastolic blood pressures in the DS group, with the exception of systolic pressure in men under 40. Fasting serum cholesterol and triglyceride concentrations were similar in the two groups, but triglyceride concentrations were significantly lower than in normal people without a history of vascular disease. These unexplained observations may be relevant in further studies of the pathogenesis of atheroma.

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A theoretical model of emission reductions is specified that accounts for voluntary and nonvoluntary behaviour regarding the adherence to the Helsinki and Sofia Protocols, which mandated emission reductions for sulphur (S) and nitrogen oxides (NO x ), respectively. From this model, we derive an econometric specification for the demand for emission reductions that adjusts for the spatial dispersion of the pollutant. When tested for 25 European nations, the model performs well for sulphur cutbacks. Less satisfying results are obtained for NO x , because the model's assumption of a unitary actor at the national level is less descriptive. Collective action considerations indicate that sulphur emissions are easier to control than those of NO x .

Objective To explore the factors that influence treatment decisionmaking in a gynaecological cancer team (MDT).Design Qualitative study using interviews and observations. Setting Gynaecological cancer MDT meetings and participants' offices.Sample A gynaecological cancer MDT and members of that team.Methods Observations of ten MDT meetings and semistructured interviews with 16 team members. Data analysis using the constant comparison technique of grounded theory and ethnography.Main outcome measures Factors affecting treatment decisions in the MDT meetings.Results Disease-centred information was central to decisionmaking, whereas patient-centred factors such as patient choice and co-morbidity were more peripheral. This was partly due to variation in team members' type and level of participation: senior clinicians occupied the most dominant roles in discussions and decision-making, whereas nurses contributed less but were more likely to focus on patient-related factors. Three main decisionmaking pathways emerged: a short discussion followed by a clear decision, a prolonged discussion ending in a definite treatment plan, and a lengthy discussion with no clearly stated decision at the end. The type of pathway followed depended on a case's complexity and the extent of agreement among team members.Conclusions The process of treatment decision-making was not consistent for all women but was affected by factors such as the complexity of the case, which team members participated, and the extent of team members' agreement. Improvements are needed to ensure patient-centred information is included for all women and that clear decisions are reached and recorded in all cases.