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.     

Factors influencing theme park visitor brand-switching behaviour as based on visitor perception

With the development of theme parks, which represent a multi-million-pound industry worldwide, research investigating the factors affecting theme park visitor brand-switching behaviour is an important method for improving theme park competitiveness. In the present work, models and research hypothesis are constructed based on visitor perception, and the survey data are collected and analysed to assess the hypothesis and to revise the conceptual model in this paper. The results indicate that there are seven factors influencing visitor brand-switching behaviour: ‘visitor variety-seeking', ‘visitor satisfaction', ‘switching cost', ‘perceived value', ‘competitor attraction', ‘theme park image' and ‘visitor involvement'. The perceived value and visitor satisfaction strongly influence brand-switching behaviour as intermediate variables. Visitor variety-seeking and competitor attraction are positively related to visitor brand switching behaviour, whereas the other five factors are negatively related to visitor brand-switching behaviour.     

中小非上市公司信用风险的评价研究——基于WEB与FAHP的视角

信用是人类社会最古老的词汇之一,而信用风险的管控是现代社会经济生活关注的核心问题之一。中小企业既是资本主义社会也是社会主义社会向前发展的源驱动力,中小企业的发展离不开现代信用体系的支撑。在文章中,中小企业按其信息的披露程度分为上市公司与非上市公司,相对于中小企业上市公司来说,由于交易的参与人信息不对称,中小非上市公司信用风险评估是交易双方以及各类金融机构最关心和最难解决的难题之一。在现代信息网络技术普遍化的背景下,利用人工以及机器搜索策略,充分挖掘中小非上市公司信息风险元和分类整理,并在此基础之上进行模糊综合评估,最后通过算例说明基于WEB对中小非上市公司信用风险的模糊综合评价的方法行之有效。     

泛长三角地区产品专业化分工实证——基于产品互补模式的研究

泛长三角区域发展分工合作是目前区域经济研究的一个热点问题。本文依据产业经济学中产业优势理论，基于产品互补模型运用产品专业化系数测算的方法，对泛长三角区域四省一市的产业结构进行了实证分析，根据得出的结论提出了分工合作建议。     

应用皮肤光毒性实验仪进行化妆品皮肤光毒性试验的研究

[目的]探讨应用皮肤光毒性实验仪进行化妆品皮肤光毒性试验的试验条件和阳性对照物8-MOP的合适试验浓度。[方法]观测皮肤光毒性实验仪的UVA光强度与开机时间的关系,并根据测得的光强度平均值计算得出光毒性试验所需的照射时间;用不同浓度的8-MOP进行试验,排除8-MOP的原发性刺激作用,选择适宜的应用浓度进行皮肤光毒性试验;对两个防晒粉底按所选仪器条件进行试验。[结果]照射开始后2-100m in,UVA光强度稳定在4.3-4.4 mW/cm^2,平均值为4.4 mW/cm^2,故试验时的照射时间为38m in;用皮肤光毒性实验仪进行光毒性试验,0.05%8-MOP能引起豚鼠皮肤明显光毒性反应并且不引起原发性刺激反应;相同试验条件下未见两种防晒粉底引起豚鼠皮肤显著光毒性反应。[结论]用皮肤光毒性实验仪进行化妆品皮肤光毒性试验可行、有效。     

基于竞争态模型的安徽省FDI来源地地域结构研究

运用竞争态模型对安徽省外商直接投资(FDI)资金市场2001-2010年统计数据进行深入分析,揭示安徽省FDI资金市场来源地地域结构时空演替规律,研究发现:安徽省FDI资金市场竞争态在时间维度上呈现出"复苏-衰退-跳跃-稳定-衰退"的复杂波动演替态势,空间维度上表现为明星市场缺失,金牛市场稳中有降,瘦狗市场和幼童市场波动较大的特征。据此,提出稳定和拓展安徽FDI资金市场若干针对性策略。     

财产保险赔款支出核算标准和数据一致性问题

本文考察和分析从2001年至2010年十年间,我国财产保险业核算赔款支出及未决赔款准备金提转差的计算标准。具体以一家具有行业代表性的财产险公司最近十年披露数据为例,并以《中华人民共和国金融行业标准——保险公司统计分析指标体系规范》(JR/T0047-2009)为标准,分别计算在实施该标准之前和之后的赔付支出、未决赔款准备金及其利润值。研究发现,实施该标准后的近十年平均赔付支出普遍增加,未决赔款准备金增加尤为显著。赔付支出和未决赔款准备金数据的变化将导致承保业绩变化,甚至导致承保周期等后续研究的结论发生改变。     

全球经济滞胀风险成因及前景

当前全球通胀压力不断加大,从欧盟的情况来看,由于减碳力度加大,碳价及能源价格暴涨正在推动电价飙升,多国PPI突破10%,创近30年之最;从美国情况来看,政策刺激力度超过次贷危机,短期内需求扩张推升了通胀;从生产要素看,疫情下的供应链中断叠加油气价格暴涨,各国都面临要素成本上升的问题;从不可控因素看,极端天气变化导致全球食品价格大幅上涨。在通胀压力与日俱增的同时,全球经济在短暂修复后出现放缓的趋势,呈现出滞胀的特征。为了避免经济滞胀向中长期演化,需要加强国际政策合作。     

Reformulating Environmentally Constrained Traffic Equilibrium via a Smooth Gap Function

Various government laws have recently been enacted to alleviate the environmental deterioration of transportation systems. Environmental constraint is a valid means to explicitly reflect various environmental protection requirements imposed by the government. In this paper, we examine the environmentally constrained traffic equilibrium problem (EC-TEP), which is a fundamental tool for modeling and evaluating environmental protection requirements. Specifically, we provide an equivalent reformulation for the EC-TEP. The proposed reformulation adapts the concept of gap function to simultaneously reformulate the nonlinear complementarity conditions associated with the generalized user equilibrium conditions, environmental constraints, and conservation constraints as an equivalent unconstrained optimization problem. This gap function reformulation has two desirable features: (1) it can handle a general environmental constraint structure (linear or nonlinear; link-based or area-based) and a general link and route cost structure, enhancing the modeling adaptability and flexibility; (2) it is smooth and unconstrained, permitting a number of existing efficient algorithms for its solution. A gradient-based solution algorithm with a self-regulated averaging stepsize scheme is customized to solve the reformulated unconstrained optimization problem. Numerical examples are also provided to demonstrate the modeling flexibility of the proposed EC-TEP reformulation.