Weekend Effect

Objective: To examine the effect of the 24-h doctors ’ strike on 21 June 2012 on hospital activity in English NHS hospitals. Design: Retrospective descriptive study of inpatient, out-patient and Accident and Emergency (A&E) activity in NHS hospitals over the strike period. Setting: All English NHS hospitals. Participants: Patients admitted to hospital, patients with outpatient appointments and A&E attendances over a three-week period (from 11 to 29 June 2012), excluding weekends and spanning the strike day. Main outcome measures: Numbers and percentage change of inpatient admissions (elective and emergency), day surgery cases, outpatient appointments cancellations, A&E attendances and in-hospital deaths on the day of the strike compared with patient activity on the Thursday before and the Thursday after the strike week. Results: There were a total of 795,267 admissions, 5,602,971 outpatient appointments, 356,645 outpatient cancellations (by NHS provider), 4,470,208 outpatients seen ...

Background The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results 367 collaborators from 59 countries responded to the survey....

Background The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results 367 collaborators from 59 countries responded to the survey....

Background The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results 367 collaborators from 59 countries responded to the survey....

Objective Routine administrative data have been used to show that patients admitted to hospitals over the weekend appear to have a higher mortality compared to weekday admissions. Such data do not take the severity of sickness of a patient on admission into account. Our aim was to incorporate a standardized vital signs physiological-based measure of sickness known as the National Early Warning Score to investigate if weekend admissions are: sicker as measured by their index National Early Warning Score; have an increased mortality; and experience longer delays in the recording of their index National Early Warning Score. Methods We extracted details of all adult emergency medical admissions during 2014 from hospital databases and linked these with electronic National Early Warning Score data in four acute hospitals. We analysed 47,117 emergency admissions after excluding 1657 records, where National Early Warning Score was missing or the first (index) National Early Warning Score wa...

Background The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results 367 collaborators from 59 countries responded to the survey....

Background The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results 367 collaborators from 59 countries responded to the survey....

Background The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results 367 collaborators from 59 countries responded to the survey....

Background The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results 367 collaborators from 59 countries responded to the survey....

Background The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results 367 collaborators from 59 countries responded to the survey....

Introduction The concept of “weekend effect”, that is, substandard healthcare during weekends, has never been fully demonstrated, and the different outcomes of emergency surgical patients admitted during weekends may be due to different conditions at admission and/or different therapeutic approaches. Aim of this international audit was to identify any change of pattern of emergency surgical admissions and treatments during weekends. Furthermore, we aimed at investigating the impact of the COVID-19 pandemic on the alleged “weekend effect”. Methods The database of the CovidICE-International Study was interrogated, and 6263 patients were selected for analysis. Non-trauma, 18+ yo patients admitted to 45 emergency surgery units in Europe in the months of March–April 2019 and March–April 2020 were included. Demographic and clinical data were anonymised by the referring centre and centrally collected and analysed with a statistical package. This study was endorsed by the Association of Ita...

IntroductionPatients admitted to hospital in an emergency at weekends have been found to experience higher mortality rates than those admitted during the week. The National Health Service (NHS) in England has introduced four priority clinical standards for emergency hospital care with the objective of reducing deaths associated with this ‘weekend effect’. This study aimed to determine whether adoption of these clinical standards is associated with the extent to which weekend mortality is elevated.MethodsWe used publicly available data on performance against the four priority clinical standards in 2015 and estimates of Trusts’ weekend effects between 2013/2014 and 2015/2016 for 123 NHS Trusts in England. We examined whether adoption of the priority clinical standards was associated with the extent to which weekend mortality was elevated, and changes over a 3 year period in the extent to which mortality was elevated.ResultsLevels of achievement of two of the four clinical standards (o...

In this paper we use fractional integration techniques to examine the degree of integration of four US stock market indices, namely the Standard and Poor, Dow Jones, Nasdaq and NYSE, at a daily frequency from January 2005 till December 2009. We analyse the weekly structure of the series and investigate their characteristics depending on the specific day of the week. The results indicate that the four series are highly persistent; a small degree of mean reversion (i.e., orders of integration strictly smaller than 1) is found in some cases for S&P and the Dow Jones indices. The most interesting findings are the differences in the degree of dependence for different days of the week. Specifically, lower orders of integration are systematically observed for Mondays and Fridays, consistently with the “day of the week” effect frequently found in financial data.

This paper explores price (momentum and contrarian) effects and their timing parameters on the days characterised by abnormal returns and the following ones in two commodity markets. Specifically, using daily gold and oil price data over the period 01.01.2009–31.03.2020 the following hypotheses are tested: (H1) there is a time gap between the detection of an abnormal return day and the end of that day, (H2) there are price effects on the day after abnormal returns occur; (H3) price effects after 1-day abnormal returns have identifiable timing parameters; (H4) the detected timing parameters can be used to “beat the market”. For these purposes average analysis, t tests, CAR and trading simulation approaches are used. The main results can be summarised as follows. Prices tend to move in the direction of abnormal returns till the end of the day when these occur. The presence of abnormal returns can usually be detected before the end of the day by estimating specific timing parameters, a...

This paper analyzes price gaps in the Ukrainian stock market for the case of UX index over the period 2009–2018. Using different statistical tests (Student’s t-tests, ANOVA, Mann-Whitney test) and regression analysis with dummy variables, as well as modified cumulative approach and trading simulation, the authors test a number of hypotheses searching for price patterns and abnormal market behavior related to price gaps: there is seasonality in price gaps (H1); price gaps generate statistical anomalies in the Ukrainian stock market (H2); upward gaps generate price patterns in the Ukrainian stock market (H3) and downward gaps generate price patterns in the Ukrainian stock market (H4). Overall results are consistent with the Efficient Market Hypothesis: there is no seasonality in price gaps and in most cases there is no evidences of price patterns or abnormal price behavior after the gaps in the Ukrainian stock market. Nevertheless, the authors find very strong and convincing evidences...

This series introduces epidemiological and medical concepts into understanding why health care costs and capacity pressures can be so volatile. COVID-19 is used as an example for many of the principles. The role of the nearness to death (NTD) effect in healthcare demand is discussed in relation to acute hospital bed utilization in U.S. states. The effect of the COVID-19 epidemic on international hospital capacity pressures is illustrated as the ratio of COVID-19 deaths per 1,000 hospital beds. Acute bed occupancy in U.S. states is compared using a new method for international bed comparison, revealing low bed occupancy relative to other developed countries. No relationship can be discerned between available nursing home beds and acute bed occupancy in U.S. states. COVID-19 deaths per 1,000 acute beds in U.S. states are also compared, along with a similar comparison with London in the UK. To illustrate the role of spatiotemporal granularity in infectious outbreaks the spread of COVID-19 through U.S. states is compared at county level. At the 16th October 2020, some 39% of U.S. counties have experienced less than a 2% increase in total deaths due to COVID-19, while just 15 cities (0.5% of counties) accounted for over 27% of COVID-19 deaths. By the 9th December, some 130 U.S. counties had not had a single COVID-19 death. The role of population density in the spread of epidemics is illustrated using COVID-19 and discussed in relation to both financial risk and hospital surge capacity. Los Angeles, a high population density city, implemented strict public health measures and initially reduced deaths by around 5- to 10-times compared to other similar high population density cities. Should health insurance policies be weighted according to small-area population density? This study raises questions, such as, does the health insurance underwriting cycle have a hidden infectious basis? Is the need for complex financial instruments in health care the outworking of our lack of fundamental understanding in this area? How big should an autonomous Health Authority or Health Insurer be to minimise financial risk? These and other issues will be discussed in the Parts 2 to 4 of this series.

This series on NHS capacity planning has highlighted the role of the nearness to death effect upon hospital inpatient demand. The absolute number of deaths serves as a retrospective measure of the end-of-life pressure faced by each locality, where around half of a person's lifetime inpatient demand is compressed into the last year of life. End-of-life demand is highly volatile NHS demand is therefore highly sensitive to the volatility in deaths. The sad fact is that deaths are highly volatile and that the magnitude of this volatility is location specific. This implies that the marginal changes in demand and cost pressures are location specific and largely outside of the control of the NHS.

Aims: To explore the interplay between information asymmetry and financial forecasting in the context of the English National Health Service (NHS). Study Design: Synthesis of the political context of the English NHS and how this impacts on the information flows to assist NHS accountants with financial forecasting. Place and Duration of Study: Monthly hospital activity data across the whole of England between 2006/07 and 2016/17, and monthly deaths by place of residence within England between 2000 and 2016. Methodology: Running 12-month totals. Cumulative activity within a financial year (April to March) adjusted for available working days per month, with examples calculated for the 2016/17 financial year. Results: The NHS in England operates in a tightly constrained policy-directed manner, in which government health agencies may omit to communicate essential information that is contrary to current policy. Long-term trends show anomalous behavior which has been used to 'blame' the NHS for failure to constrain health care demand, and as the basis of the need for further 'corrective' policies. A running 12-month total is presented as a useful method to detect activity trends subject to non-standard behavior. The role of volatility associated with health care trends is emphasized. Volatility arises from Poisson-based variation due to size, and the effects of the environment on human health, i.e. changes in weather, air quality, noise levels, and outbreaks of infectious agents. Volatility is therefore location specific. After adjusting for the number of available work days per month, cumulative monthly activity data can also be used to calculate year-end outturn from any point in the financial year. Multiple years of historic data can be converted into the current financial year equivalent which enables both the median, minimum and maximum potential outturn to be estimated, i.e. with allowance for location-specific volatility. For example, activity totals for month six of the 2016/17 financial year for emergency admissions across England can be multiplied by anywhere between 2.001 to 2.046 to estimate year end, while costs related to end-of-life can be multiplied by 1.945 to 2.258 in West Berkshire or between 1.890 to 2.304 in Redditch (as examples of the effects of size and location). Conclusion: Information asymmetry is not unique to the NHS in England. Running 12-month totals are a simple method which can be employed by finance departments to detect unusual long-term trends. The activity multiplier method, based on multiple years of historic data, is simple and can be used to estimate a likely year-end position, along with upper and lower limits.

Aims: To investigate the need for additional critical care beds, the potential for economy of scale in larger units, including ratios to support the choice of bed numbers. Study Design: Time trend analysis and construction of useful ratios to assist planning. Place and Duration of Study: Operational data for English NHS hospitals (2011 to 2016) obtained from NHS agencies. Analysis of critical care data at King's College Hospital from April 2013 to February 2016. Methodology: Analysis of time trends and/or calculation of averages and ratios of critical care beds per total hospital beds in different categories. Results: In England, demand for critical care beds is growing at around 2.6% per annum. In 2015/16, the ratio of critical care beds to total hospital beds ranges from an average of 1:5 in tertiary/specialist hospitals to a minimum of 1:50 in general hospitals. Ratio of neonatal beds to maternity beds is around 1:5. Critical care units with more than 35 beds (adult, pediatric or neonatal) operate at around 85% annual average occupancy. Average monthly occupancy across the whole of England correlates with total monthly cancelled urgent operations. Conclusion: Smaller units require far higher levels of flexibility in staffing and will suffer the unavoidable consequences of higher costs and the knock-on effects of periods of 100% occupancy. Smaller units must become part of a larger network in order to compensate for the higher volatility in CCU demand as size reduces.

Past and recent trends in medical and other admissions in England are examined to determine if the increasing elderly population is the sole source for pressures in the NHS arising from large increases in medical admissions. Unusual step-like events appear to lie behind the unexplained growth in medical admissions. Age banded trends since 2012/13 show evidence for age-specific patterns of growth which are similar to patterns in immunity arising from antigenic original sin, i.e. repeated priming of the immune system and consequent antibody landscapes arising from lifetime exposure to different strains of the same agent. Contrary to common belief, age-standardised growth in medical group (general and elderly medicine, etc.) admissions is highest in the younger age bands, except for children. As opposed to the medical group, age standardised growth in the oncology (oncology, radiotherapy) group occurs to the greatest extent in the youngest and oldest. Periods of unexplained higher deaths which accompany these events have been overlooked by traditional disease surveillance methods, and hidden patterns in deaths can be revealed by the use of cumulative sum of deviations from the mean (CUSUM), and running 12 month total analysis. Interactions between a suspected infectious agent and influenza appear likely. Changes in the gender ratio at birth around the time of the 1918 'Spanish flu' epidemic suggest the potential involvement of a second agent. The pattern of conditions most affected shows some evidence for common immune function aetiology, and the immune modifying virus cytomegalovirus may be in some way involved in these events either as cause or via opportunistic reactivation.

A series of clustered infectious-like events have been recently documented in both the northern hemisphere (Canada, UK [England, Northern Ireland, Scotland and Wales], all countries in the European Union, and the USA) and the southern hemisphere (Australia and New Zealand), in which both deaths and emergency admissions for a range of medical conditions appear to simultaneously rise in a step-like manner, stay high for a period of 12 to 18 months, and then revert back to the expected time trajectory. These unique events are also observed in very small geographical areas within the population area of a single hospital or Primary Care Organisation (PCO), and this precludes explanations based on acute thresholds to admission or to PCO funding, procedures and practice. These events have been overlooked by traditional health surveillance methodologies, simply because it was assumed that neither deaths nor medical admissions could behave in this unique way. Indeed, in the UK it has been widely assumed that the increases in medical admissions arising from these events are solely due to deficiencies in the organization and delivery of health and social care, often labelled as 'failure to manage demand'. Based on the spectrum of medical conditions which are associated with the increased admissions  and deaths, it has been proposed that the ubiquitous herpes virus, cytomegalovirus (CMV), may in some way be associated with these outbreaks. This involvement could be either by (re-)infection with a new strain, or by opportunistic reactivation in the presence of another agent. This review will examine if CMV is indeed capable of causing substantial increases in both deaths and medical admissions, and which conditions in particular would be affected.

Aims: To determine if a score (PCA score derived from Principal Component Analysis), a validated score of frailty and mortality, based on 12 blood biochemistry parameters can shed light on the issue of patient acuity, end of life and weekend mortality in hospitals. Study Design: The PCA score was calculated from over 280,000 blood tests. Average PCA score was calculated for different patient groups on different days of the week. An accompanying literature review of day-of-week variation in human mental and physical performance, and of studies investigating hospital mortality. Place and Duration of Study: Retrospective analysis of 280,000 blood test results from 80,000 patients attending the Milton Keynes University Hospital in the interval January 2012 to July 2015.  Participants: Patients at outpatient clinics, the emergency department or as an inpatient who had one or more blood samples comprising the 12 biochemical tests. Methodology: Average PCA score was calculated for patients in different hospital departments, on different days of the week, in different age groups, and at different times prior to death. Results: The PCA score for individual’s ranges from -6 to +6, with scores above zero generally associated with higher morbidity and mortality. The average PCA score is lowest in outpatient and A+E settings, varies across wards dedicated to different types of inpatient care, and is highest in ICU. The average PCA score reaches a minimum around age 18, and shows a modest increase with age in those who are not an inpatient. There is a day-of-week variance in the PCA score which is higher at the weekends, and dips to a minimum around Wednesday. The strength of the day-of-week effect varies by age and condition, and occurs in locations where staffing levels remain constant throughout the week.  Conclusions: Variation in human blood biochemistry follows day-of-week patterns and responds to different conditions, age, and the acuity of the condition. These add further weight to the argument that weekend staffing levels, and proposed 7 day working patterns, do not take account of all the factors that contribute to a day-of-week variation in hospital mortality and morbidity.

The presence of seasonality in stock returns violates the weak form of market efficiency because equity prices are no longer random and can be predicted based on past pattern. This facilitates market participants to devise trading strategy which could fetch abnormal returns on the basis of past pattern. Fluctuations in the stock returns of firms listed at Nairobi Securities exchange motivated this study. In the Kenyan context, studies conducted on market anomalies in different markets have continued to yield different results in the majority of the investigated markets including the Nairobi Securities Exchange. This paper examines whether there is a significant variation in the average daily stock returns at the NSE and compares the findings to the previous empirical works on the topic. The paper tested for the presence of the Monday effect, differences in mean return across the five trading days, January effect, differences in the mean return across the five trading months and also provided the day-today and year-to-year behavior of stock return at the NSE. The study employed daily data from the year 2001 to 2015 to do analysis. The method of analysis was t tests and ANOVA. Policy recommendations are afterwards presented to aide the investors in making key investment decisions.

Background
Previous studies indicate that risk of mortality is higher for patients admitted to acute hospitals at the weekend. Thus, there is a drive to move towards provision of a 7 day health-care service in the UK. However, less is known about variations in clinical outcomes among patients admitted to psychiatric hospitals. We sought to investigate variations in clinical outcomes for patients admitted to a psychiatric hospital at the weekend.

Methods
The study was conducted with anonymised electronic health record data from the South London and Maudsley NHS Foundation Trust. Data were obtained from all consecutive admissions to psychiatric hospitals within the Trust between April 1, 2006, and March 31, 2015, with the Clinical Record Interactive Search tool. The association of weekend or bank holiday admission with duration of admission, risk of readmission, and inpatient mortality were investigated by multivariable regression analyses with age, sex, and ethnicity as covariates. Secondary analyses were performed to investigate the distribution of admissions, discharges, inpatient mortality, episodes of seclusion, and violent incidents on different days of the week.

Findings
7303 (16·1%) of 45 264 admissions commenced during a weekend or bank holiday. Patients who were aged between 26 and 35 years, female, or from a minority ethnic group were more likely to be admitted at the weekend. Patients admitted at the weekend were more likely to present via acute hospital services, other psychiatric hospitals, or the criminal justice system than to be admitted directly from their own home. Weekend admission was associated with a shorter duration of admission (β coefficient −21·1 days, 95% CI −24·6 to −17·6; p<0·001) and increased risk of readmission in the 12 months after index admission (incidence rate ratio 1·13, 1·08–1·18; p<0·001) but no significant difference in inpatient mortality (odds ratio 0·79, 0·51–1·23) compared with weekday admission. Fewer episodes of seclusion occurred at the weekend (χ2=15·8, p=0·02) but there was no significant variation in deaths during hospital admission or violent incidents on different days of the week.

Interpretation
We show that patients admitted at the weekend had shorter admissions and increased risk of readmission but no significant difference in risk of inpatient mortality compared with those admitted during the week. This finding contrasts with previous studies in acute hospitals where weekend admission is typically associated with increased likelihood of inpatient mortality, and highlights a need to consider variations in demand when implementing health-care services across a 7 day week.

Funding
National Institute for Health Research, Medical Research Council.

This paper provides some new empirical evidence on the weekend effect, one of the most recognized anomalies in financial markets. Two different methods are used: (i) a fractional integration technique for the estimation of the degree of integration of the series (d); (ii) a trading robot approach to examine whether or not there is such an anomaly giving rise to exploitable profit opportunities by replicating the actions of traders. The lowest orders of integration are generally found on Mondays, which can be seen as evidence for a weekend effect. However, the trading robot analysis shows that this anomaly cannot be exploited to make abnormal profits, and therefore it is not inconsistent with the Efficient Market Hypothesis (EMH).

Abstract: This paper presents a classroom experiment where students participate in a simulated futures market. This experiment can be run in about an hour and allows students to interact, negotiate, try different strategies, see how their accounts are closed, and observe how spot and futures markets relate. After participating in the futures experiment, students participate in a debriefing session to help them solidify their learning. This experiment can be successfully adopted in undergraduate finance education.