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.     

The international business cycle as intertemporal coordination failure

Where investments are irreversible and the future is uncertain, people in two countries can make investment decisions that turn out to be mutually inconsistent. I argue that this intertemporal coordination failure explains international business cycles in a two-currency-area setting with a floating foreign exchange rate. The sequence of events starts with an expansionary domestic monetary shock, which decreases the domestic real interest rate. Facing low transactions costs, people spend the new money relatively early in the foreign exchange market and in the foreign market for loanable funds. Domestic monetary expansion thereby changes the relative prices of domestic and foreign goods and also of goods of earlier and later stages of production. The relative price changes lead to intertemporal and international coordination failures once the monetary expansion ends and relative prices change. Domestic monetary policy thereby causes the comovement across different currency areas we observe of business cycles.     

Intertemporal capital substitution and Hayekian booms

Hayek’s business cycle theory portrays monetary expansion and monetary contraction with counterintuitive asymmetry. On the one hand, it suggests that they both change relative prices and cause costly reallocations of production factors. At the same time, the theory predicts that while a monetary contraction causes the economic crisis, the monetary expansion comes with the boom. I argue that what I call intertemporal capital substitution in industries close to final consumption explains why there is a boom in spite of the costly reallocations. More specifically, monetary expansion only gradually increases the demand for nonspecific factors of production by industries that are temporally remote from final consumption. Responding to the expected higher cost of nonspecific factors, consumer-goods industries temporarily increase output and depreciate specific durable production factors faster than they planned.     

Benevolent leadership and follower performance: The mediating role of leader–member exchange (LMX)

This study examines leader?Cmember exchange (LMX) as a mediator of the relationship between benevolent leadership and follower task performance and extra-role performance. Using a sample of 223 leader?Cmember dyads in a nonprofit organization in the People??s Republic of China, results indicate that benevolent leadership and LMX are positively related to follower task performance and organizational citizenship behavior towards the organization (OCBO). Findings also support that LMX partially mediates the relationship between benevolent leadership and follower task performance as well as fully mediates the relationship between benevolent leadership and OCBO. Implications for the theory and practice of leadership in Asia are discussed.     

Management,Organizational Justice and Emotional Exhaustion among Chinese Migrant Workers: Evidence from two Manufacturing Firms

This article explores how Human Resource (HR) policies and practices influence employee perceptions of organizational justice, which in turn impacts employee emotions and feelings of emotional exhaustion. Using structural equation modelling and based on employee survey data drawn from two manufacturing organizations, we find that a strong HR system — perceived by workers as distinctive, attractive and consistently implemented — fosters perceptions of distributive, procedural and interactive justice. However, only distributive injustice leads to negative emotions and emotional exhaustion. This is explained by reference to the cultural and institutional context (China), status (migrant) and type of workers (semi‐skilled, manual) included in the study. We discuss the theoretical and practical implications that arise from these findings.     

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.