Medication,equipment, and supply costs for common interventions providing extended post-surgical analgesia following total knee arthroplasty in US hospitals

Aims: To estimate the cost to hospitals of materials (i.e. medications, equipment, and supplies) required to administer common interventions for post-surgical analgesia after total knee arthroplasty (TKA), including single-injection peripheral nerve block (sPNB), continuous peripheral nerve block (cPNB), periarticular infiltration of multi-drug cocktails, continuous epidural analgesia, intravenous patient-controlled analgesia (IV PCA), and local infiltration of bupivacaine liposome injectable suspension (BLIS).

Materials and methods: This analysis was conducted using a mixed methods approach combining published literature, publicly available data sources, and administrative data, to first identify the materials required to administer these interventions, and then estimate the cost to the hospital of those materials. Medication costs were estimated primarily using the Wholesale Acquisition Costs (WAC), the cost of reusable equipment was obtained from published sources, and costs for disposable supplies were obtained from the US Government Services Administration (GSA) database. Where uncertainty existed about the technique used when administering these interventions, costs were calculated for multiple scenarios reflecting different assumptions.

Results: The total cost of materials (i.e. medications, equipment, and supplies) required to provide post-surgical analgesia was $41.88 for sPNB with bupivacaine; $756.57 for cFNB with ropivacaine; $16.38 for periarticular infiltration with bupivacaine, morphine, methylprednisolone, and cefuroxime; $453.84 for continuous epidural analgesia with fentanyl and ropivacaine; $178.94 for IV PCA with morphine; and $319.00 for BLIS.

Limitations: This analysis did not consider the cost of healthcare providers required to administer these interventions. In addition, this analysis focused on the cost of materials and, therefore, did not consider aspects of relative efficacy or safety, or how the choice of intervention for post-surgical analgesia might impact outcomes such as length of stay, re-admissions, discharge status, adverse events, or total hospitalization costs.

Conclusions: This study provided an estimate of the costs to hospitals for materials required to administer commonly used interventions for post-surgical analgesia after TKA.     

Firepower: Geopolitical Cultures in the Anthropocene

ABSTRACT

The human control of fire is a relatively neglected part of the discussion of the contemporary transformation of the planet. Thinking about it in terms of geopolitics is a way to link climate adaptation, extinction and the possibilities of extending traditional analyses of political ecology to the global scale. Such thinking is explicitly rejected as the appropriate premises for foreign policy action by the Trump administration which poses American greatness in terms of traditional understandings of firepower. This clash of geopolitical cultures is now key to global politics, where dramatic landscape transformation, related species extinctions as well as climate change results directly and indirectly from human control of combustion. Firepower is a matter of military technology as well as, in the form of fossil fuel combustion, the essential energy source that fuels the global economy. Focusing on combustion as a key geophysical force in contemporary geopolitics offers useful insights into the Anthropocene discussion and, in particular, the two planetary boundaries of climate change and biodiversity loss, which are key to contemporary efforts at global environmental governance.     

Combination of “combinations of <Emphasis Type="Italic">p</Emphasis> values”

We investigate the impact of an uncertain number of false individual null hypotheses on commonly used p value combination methods. Under such uncertainty, these methods perform quite differently and often yield conflicting results. Consequently, we develop a combination of “combinations of p values” (CCP) test aimed at maintaining good power properties across such uncertainty. The CCP test is based on a simple union–intersection principle that exploits the weak correspondence between two underlying p value combination methods. Monte Carlo simulations show that the CCP test controls size and closely tracks the power of the best individual methods. We empirically apply the CCP test to explore the stationarity in real exchange rates and the information rigidity in inflation and output growth forecasts.     

The ABC of complementary products mergers

We present a simple model where mergers benefit consumers, harm outsiders and, depending on the shape of demand, can be profitable for insiders (and where mergers do not involve cost synergies).     

Comparing three ways to update Choquet beliefs

We analyze three rules for updating neo-additive capacities. Only for Generalized Bayesian Updating is relative optimism the same for both updated and unconditional capacities. For updates of the other two, either the updated capacity is fully optimistic or fully pessimistic.     

Aid and public sector fiscal behaviour in failing states

This paper looks at interactions between foreign aid and the public sector in developing countries, especially those considered to be fragile or failing states. A model is proposed which employs actual budgetary appropriations and revenue estimates (rather than estimated target variables) and allows for asymmetric preferences. Variants of the model are estimated using time-series data for Papua New Guinea (PNG). PNG is classified as a fragile state by the international community owing to perceived policy and institutional inadequacies. Results obtained suggest that foreign aid increases consumption and investment expenditures and decreases tax revenues and the level of borrowing.     

经济增长与农村反贫困

本文利用中国家庭收入项目(CHIP)调查数据,估计了1988-2002年期间的中国农村绝对贫困、收入差距的变化趋势及收入增长和收入分配变化对农村贫困的影响.根据CHIP调查数据所绘制的贫困发生曲线表明,不论把绝对贫困线确定在哪里,在该时期内中国农村贫困都在显著下降.贫困指数分解和面板数据回归结果均显示收入增长是导致贫困下降的主要原因.     

Die Debatte um die deutsche Exportorientierung

Die in vielen L?ndern gewachsene Einkommensungleichheit wird international zunehmend als eine wesentliche Ursache für die Weltwirtschaftskrise und die globalen Ungleichgewichte im Au?enhandel hervorgehoben. Hingegen ist die Debatte in Deutschland teilweise noch immer durch die Forderung nach weiterer Lohnzurückhaltung und sozialpolitischen Einschnitten gekennzeichnet. Welche Rolle kann die Lohn- und Verteilungspolitik zur mittelfristigen überwindung der deutschen Exportlastigkeit und zur Stabilisierung der deutschen und globalen Wirtschaft spielen?     

Inscribing the American Body Politic: Martin Sheen and Two American Decades

Film and television have been influential in the remaking of the American self since the traumas of Vietnam. We undertake readings of class, gender, ethnicity and race focusing on the roles of Martin Sheen and his two ‘crews’ in Apocalypse Now Redux and in the television series The West Wing. We argue that despite the appearance of a more progressive America as represented by the Bartlet White House it remains within a long tradition that represents the US in discourses of innocence and pureness of will and is largely blind to the kind of violence perpetrated by Willard and his crew in Apocalypse Now Redux. We suggest that the capacity of the US repeatedly to ‘forget’ its use of certain kinds of violence marks the limits of self-sacrifice of the American self and provides the discursive possibility for the eternal return of innocence.     

Mean-reversion properties of implied volatilities

In this paper, we present a new stylized fact for options whose underlying asset is a stock index. Extracting implied volatility time series from call and put options on the Deutscher Aktien index (DAX) and financial times stock exchange index (FTSE), we show that the persistence of these volatilities depends on the moneyness of the options used for its computation. Using a functional autoregressive model, we show that this effect is statistically significant. Surprisingly, we show that the diffusion-based stochastic volatility models are not consistent with this stylized fact. Finally, we argue that adding jumps to a diffusion-based volatility model help recovering this volatility pattern. This suggests that the persistence of implied volatilities can be related to the tails of the underlying volatility process: this corroborates the intuition that the liquidity of the options across moneynesses introduces an additional risk factor to the one usually considered.