Hospital costs associated with thyroidectomy performed with a Harmonic device compared to conventional techniques: a systematic review and meta-analysis

Objectives: Harmonic devices have become a world-wide standard for dissection and hemostasis in thyroidectomy. Numerous systematic reviews have reported superior operating times, blood loss, post-operative pain, length of stay, and overall safety outcomes. What has not been extensively evaluated in a robust manner is their economic impact. The purpose of this study is to evaluate the hospital costs associated with open thyroidectomy using Harmonic devices compared with conventional techniques for hemostasis. Methods: A systematic review of Medline, Scopus, and CENTRAL was performed from January 1, 2000 to May 23, 2014 without language restrictions for randomized clinical trials comparing Harmonic surgical devices to conventional methods in thyroidectomy. The main outcome measure was total reported costs. Costs were pooled using the ratio of means and a random effects model. Sensitivity analyses assessed whether differences in patient and trial characteristics, healthcare setting, or choice of statistical model affected outcomes. Results: Seven studies met the inclusion criteria. A total of 476 participants had procedures performed with Harmonic devices and 478 with conventional monopolar electrosurgery and clamp, cut and tie techniques. Compared with conventional techniques, Harmonic devices reduced total reported costs by 10% (p?=?0.007), resulting in a $229?US dollars (USD) absolute reduction from mean baseline costs. Results remained relatively robust to additional sensitivity analyses. Conclusions: This systematic review and meta-analysis demonstrates that the Harmonic family of surgical devices is associated with a reduction in total reported costs in thyroidectomy compared with conventional techniques. A large portion of the overall savings derives from a reduction in operative costs.     

The iconicity of celebrity and the spiritual impulse

Celebrity has a powerful material presence in contemporary consumer culture but its surface aesthetic resonates with the promise of deeper meanings. This Marketplace Icon contribution speculates on the iconicity of celebrity from a spiritual perspective. The social value or authenticity of contemporary celebrity, and the social processes through which it emerges, are matters of debate amongst researchers and competing approaches include field theory, functionalism, and anthropologically inflected accounts of the latent need for ritual, myth and spiritual fulfillment evinced by celebrity “worship.” We focus on the latter area as a partial explanation of the phenomenon whereby so many consumers seem so enchanted by images of, and stories about, individuals with whom they, or we, often have little in common. We speculate that the powerful presence of celebrity in Western consumer culture to some extent reflects and exploits a latent need for myths of redemption through the iconic character of many, though by no means all, manifestations of celebrity consumption.     

Veblen,leisure and human need

Although Veblen's theory of leisure is widely referenced today it is rarely discussed at length. This paper explores the continuing relevance of the theory. In particular it concentrates on the relation of the theory to consumer culture and the concept of leisure as a basic human need. The evolutionary aspects of Veblen's discussion, which are often neglected in secondary accounts, are given prominence. Veblen's theory is described as a contribution to the productivist tradition in leisure studies. The main features of this tradition and Veblen's place in it are examined. The productivist case is compared and contrasted with Huizinga's theory of play. Veblen's theory emerges as a flawed but vital instrument in exploring contemporary leisure forms.     

旅游对传统村落的影响研究——以安徽齐云山为例

旅游影响一直是国内外旅游研究的重要课题,旅游地居民对旅游发展的感知是研究旅游影响的重要途径。此次调查以安徽省黄山市休宁县齐云山为例,采用问卷调查和现场访谈相结合的方式,运用SPSS、CATPACTM等软件对调查结果进行数理统计,从居民与游客角度分析了旅游开发给齐云山居民带来的经济、社会文化、环境的若干影响,以及居民对旅游业所持的态度。文章着重于探讨居民对于因旅游开发所带来的村落影响的感知,以及他们对于当前旅游影响的评测和对未来旅游发展的期待。     

中国经济复苏将经历一段曲折之路

【美国《华尔街日报》5月25日】中国经济似乎正在丧失增长动力，一些经济领域在一度出现井喷式增长后，目前显现了增速放缓迹象，不过经济学家们说，现在就断言中国的经济复苏已经终止还为时尚早。     

Effect of Diversity of Large Wildlife Species on Financial Benefits to Local Communities in Northwest Namibia

There exist few quantitative assessments of the relationship between biodiversity per se and economic benefits at scales that are relevant for conservation. Similarly, the merits of Community-Based Natural Resource Management programs for both wildlife and people are contested. Here, we harness two databases, on wildlife surveys and financial benefits, to address these issues for communal conservancies in northwest Namibia. We use ordination methods to characterize the diversity and stability of large wildlife assemblages on conservancies, and demonstrate that diversity (but not stability) is an important explanator of conservancy financial benefits. Our results indicate that for this area of Namibia, biodiversity, as represented by large wildlife assemblages, has an important, positive effect on the tangible financial benefits that people derive from conservation programs.     

Deonance and Distrust: Motivated Third Party Information Seeking Following Disclosure of an Agent’s Unethical Behavior

This article explores the hypothesis that third parties are motivated to seek information about agents who have behaved unethically in the past, even if the agent and available information are irrelevant to the third parties’ goals and interests. We explored two possible motives for this information seeking behavior: deonance, or the motive to care about ethics and justice simply for the sake of ethics and justice, and distrust-based threat monitoring. Participants in a consumer decision task were found to seek out information about an agent who had behaved unethically even when the agent was explicitly excluded from the task; there were no intentions to purchase from the agent; performance expectations for the agent’s product were low; the information that could be sought was non-diagnostic, redundant or irrelevant to an ethical judgment; and alternatives in the market offered as good or better value as the unethical agent. Critically, this information seeking took place even when the observer could disengage from and was not vulnerable to the agent. The findings are discussed in terms of third party information seeking and its effects on ethical behavior in the marketplace.     

Labour-Market Developments at a Time of Heightened Uncertainty

These are testing times for labour-market policies in Indonesia. The country faces two major challenges in an unpredictable international and domestic environment: providing people with better, more secure jobs and raising productivity to help raise living standards and reduce poverty. Over the past several months, new global and domestic threats to economic growth have emerged and may hinder progress in jobs and productivity. In the longer term, the government is searching for new strategies to increase productivity, with a focus on supply-side investments in skills and training. In relation to events abroad, uncertainty has increased over the early initiatives taken by the new US president and his nationalist administration, such as the scuttling of the Trans-Pacific Partnership trade deal. At home, likely to be of some significance for economic policy are mass actions that were levelled against Jakarta’s governor but de facto also directed against the government. In the medium term, our assessment of the record of the Joko Widodo (Jokowi) government on the labour market is mixed. Over the past two years, growth has been slower than under the previous administration and hence job creation has also been muted. The experience of a handful of countries in Asia suggests that the government might have done more to stimulate economic growth and create jobs. The disappointing performance of manufacturing stands out. Yet inflation has fallen and the slide in the value of international trade—both exports and imports—has reversed in recent months. Improved fiscal management and a generally successful tax amnesty are other pluses. There was also an unexpected but considerable fall in unemployment in 2015–16, according to labour-force statistics. Some policies, such as the new approach to minimum wages, seem to have had beneficial effects for both business and the economy, and Indonesia has done well in some international rankings, such as the World Bank’s Ease of Doing Business index. However, the picture for the medium to longer term seems less bright for the labour market. There has been much talk about raising productivity by improving skills through government support for investment in training and apprenticeships, as well as by expanding vocational training along the lines of the German model. Expanding tourism is seen as one solution to the lack of employment for young secondary- and tertiary-educated jobseekers. But we have an impression of policy-making on the run; often, the argument for government intervention has not been made clearly enough. We argue that Indonesia still lacks a coherent, well-thought-out plan to increase jobs and productivity.