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.     

Assessing impact of regulatory risk on shareholders’ wealth

Research indicates that regulatory risk increases required return on investment by investors and causes underinvestment in industries with high sunk costs. The effects of regulatory changes may be measured by estimating the abnormal returns associated with the event. The results may suggest to regulators what should be encouraged or avoided. This article utilizes a fixed effects regression to examine abnormal returns from changes in Philippine nationalization regulations. The results are consistent with extant literature. Supreme Court decisions, which increased uncertainty and regulatory risk, produced negative abnormal returns. The initial release of draft implementing rules did not produce statistically significant effects, but a succeeding draft favouring liberalization, produced positive abnormal returns.     

Risk-based decision analysis in support of precautionary policies

A decision-analytic model for avoiding a risky activity is presented. The model considers the benefit and cost of avoiding the activity, the probability that the activity is unsafe, and scientific tests or studies that could be conducted to revise the probability that the activity is unsafe. For a single decision maker, thresholds are identified for his or her current subjective probability that the activity is unsafe. These thresholds indicate whether the preferred course of action is avoiding the activity without further study, engaging in the activity without further study, or conducting a test or research programme to obtain additional information and following the result. When these thresholds are low, precautionary action is more likely to be warranted. When there are multiple stakeholders, differences in their perceptions of the benefit and cost of avoidance and differences in their perceptions of the accuracy of the additional information provided by the test or research programme combine to create differences in their decision thresholds. Thus, the model allows for the rational expression of differences among parties in a way that highlights disagreements and possible paths to conflict resolution. The model is illustrated with an application to phytosanitary standards in international trade and examined in terms of recent empirical research on lay perceptions of risks, benefits, and trust. Further research is suggested to improve the elicitation of model components, as a way of fostering the legitimate application of risk-based decision analysis in precautionary policy making.     

Impact of Auditor Report Changes on Financial Reporting Quality and Audit Costs: Evidence from the United Kingdom

While substantial revisions to auditor reporting requirements are being implemented internationally, the impact of these reforms on financial reporting quality is unknown. We exploit the United Kingdom's recent auditor reporting changes and find that the United Kingdom's new reporting regime is associated with an improvement in financial reporting quality as proxied by significant decreases in absolute abnormal accruals and the propensity to just meet or beat analyst forecasts, and a significant increase in earnings response coefficients. As for audit costs, we do not find a significant change in audit fees or audit delay surrounding the implementation of the new reporting regime. Taken together, the results of this study suggest that new auditor reporting requirements are associated with a significant improvement in financial reporting quality without detecting a significant increase in audit costs.     

Growth Enhancement Support Scheme (GESS) and Farmers’ Fertilizer Use in Rural Nigeria

Fertilizer use in Nigeria is estimated at 13 kg/ha, which is far below the 200 kg/ha recommended by the Food and Agricultural Organization (FAO). The objective of this investigation was to identify the determinant factors of farmers’ participation in Nigeria's Growth Enhancement Support Scheme (GESS). In addition, we determined the impact of the GESS on fertilizer use in rural areas. A total of 1,200 rural farmers were sampled across the six geopolitical zones of Nigeria. Results from the use of a recursive bivariate probit model indicated that GESS significantly impacted on the access and usage of fertilizer among the rural farmers; and that contact with extension agents, ownership of mobile phones, power for charging phone batteries, value output, mobile network coverage, ability to read and write were positive determinants of rural farmers’ participation in the GESS; whereas increased distance to registration and collection centers, and cultural constraints to married women reduced farmers’ tendency to participate in the GESS. The findings suggest that farmers’ participation in the GESS is a critical factor for raising fertilizer use in Nigeria. This implies that food security in sub‐Saharan Africa can be achieved by increasing the participation of rural farmers in the GESS.     

Intentions to Report Questionable Acts: An Examination of the Influence of Anonymous Reporting Channel,Internal Audit Quality,and Setting

The Sarbanes–Oxley Act of 2002 requires audit committees of public companies’ boards of directors to install an anonymous reporting channel to assist in deterring and detecting accounting fraud and control weaknesses. While it is generally accepted that the availability of such a reporting channel may reduce the reporting cost of the observer of a questionable act, there is concern that the addition of such a channel may decrease the overall effectiveness compared to a system employing only non-anonymous reporting options. The rationale underlying this concern involves the would-be reporter’s likelihood of reporting, the seriousness with which the organization treats an anonymous report, and the organization’s ability to thoroughly follow-up the report. Thus, we explore the extent to which the availability of an anonymous reporting channel influences intended use of non-anonymous reporting channels. Further, in response to Sarbanes–Oxley and the environment of financial scandals that led to its passage, many firms are strengthening their internal audit departments, and providing them with greater independence from upper management’s direct control. Accordingly, our examination tests whether the intended use of the internal audit department as an internal reporting channel is greater when the internal audit department is of “high” versus “low” quality. Finally, the study investigates intended reporting behavior across three different cases (e.g., settings). Results show that the existence of an anonymous channel does reduce the likelihood of reporting to non-anonymous channels, that generally the internal audit department quality does not affect reporting to non-anonymous channels, and that case-setting affects the type of channel to be used. Implications from the study are discussed.     

Innovations,patent races and endogenous growth

This paper presents a model of innovations and endogenous economic growth with two main assumptions: first, the cost of searching for innovations differs across innovations, and second, innovations take time to find. The paper shows that given these two assumptions together, competition leads to patent races and to duplication of innovative activity. The paper then shows that duplication significantly reduces the effect of scale on growth. It also shows that competitive R&D creates too much research on easy innovations, and too little research on the difficult ones. Finally, the paper shows that risk sharing might increase duplication and reduce growth.