Case Of Large Number Research Articles

Efficacy, Reliability, and Safety of Completely Autologous Fibrin Glue in Neurosurgical Procedures: Single-Center Retrospective Large-Number Case Study.

Commercially available fibrin glue (Com-FG), which is used commonly worldwide, is produced with pooled human plasma from multiple donors. However, it has added bovine aprotinin, which involves the risk of infection, allogenic immunity, and allergic reactions. We evaluate the efficacy, reliability, and safety of completely autologous fibrin glue (CAFG). From August 2014 to February 2016, prospective data were collected and analyzed from 153 patients. CAFG was prepared with the CryoSeal System using autologous blood and was applied during neurosurgical procedures. Using CAFG-soaked oxidized regenerated cellulose and/or polyglycolic acid sheets, we performed a pinpoint hemostasis, transposed the offending vessels in a microvascular decompression, and covered the dural incision to prevent cerebrospinal fluid leakage. The CryoSeal System had generated up to a mean of 4.51 mL (range, 3.0-8.4 mL) of CAFG from 400 mL autologous blood. Com-FG products were not used in our procedures. Only 6 patients required an additional allogeneic blood transfusion. The hemostatic effective rate was 96.1% (147 of 153 patients). Only 1 patient who received transsphenoidal surgery for a pituitary adenoma presented with the complication of delayed postoperative cerebrospinal fluid leakage (0.65%). No patient developed allergic reactions or systemic complications associated with the use of CAFG. CAFG effectively provides hemostatic, adhesive, and safety performance. The timing and three-dimensional shape of CAFG-soaked oxidized regenerated cellulose and/or polyglycolic acid sheets solidification can be controlled with slow fibrin formation. The cost to prepare CAFG is similar compared with Com-FG products, and it can therefore be easily used at most institutions.

Uncertainty and the Choice of Policy Instruments A Note On Baumol and Oates Propositions

Baumol and Oates' propositions, the irrelevancy of benefit uncertainty and the importance of cost uncertainty on the choice between a tax and a system of marketable permits, are limited to a large-number case in which the opportunities for victims of pollution to participate in a permit market are non-existent. However, with the evolution of environmental groups and coalitions of victims in neighborhoods, the large-number case can easily transform into a small-number case. This paper shows that when the pollution standard, set at what appears to be optimal ex ante, is excessively lenient, the system of marketable permits offers such groups a flexibility to buy pollution permits in a competitive market and destroy them until the optimal solution is realized. In the reverse situation, however, Baumol and Oates propositions are unambiguously valid.

Common law and the environment: Reply

I feel extremely honoured that my modest contribution (Sillner, 1994) has been found interesting enough to be discussed on the pages of this journal. Especially, I am grateful to Reimund Schwarze whose comment (see pp. 201-205), has given me the opportunity to clarify some issues which might possibly have given rise to misunderstandings. First of all, let me emphasize that my article contrasted common law with statutory law, not private law with public law. Contrary to what Schwarze sometimes seems to insinuate, I did not doubt the important role of liability in environmental policy; I advocated, however, statutory liability instead of common law rules. I thought I made this sufficiently clear (Sillner, 1994: 80, n. 2), but maybe I should have been more explicit. My critique of common law is based upon, first, its inefficiency in the case of many, and the most important, environmental problems (section 3 of my article) and, second, upon its too narrow focus (section 4 of my article). Schwarze finds faults with both of my arguments. As to his comments on the first one, I have to admit that my discussion might have left the impression that the small-number cases are unimportant and do not merit economic analysis. I surely did not mean to imply this and I agree with Schwarze on the economic relevance also of small-number cases. On the other hand, I do not find his arguments in favour of the efficiency of common law in large-number cases very convincing: in fact, all the examples he gives go to show that common law is in itself insufficient to deal with environmental problems affecting large numbers of people: The Exxon Valdez rulings, e.g., would probably have been impossible without statutes such as CERCLA which standardized and simplified the complex and cumbersome judicial procedure of liability (Dunford, 1992). The enactment of these statutes was motivated, inter alia, by the very failure of common law in similar cases: For example, the trial of the 1977 Amoco Cadiz oil spill has got nowhere for more than a dozen years (Tietenberg, 1992: 13-14). For the issue at hand it is decisive that the codification of liability in CERCLA (and, later, in the Oil Pollution Act) was thought to be necessary, and not that Congress for that purpose drew upon otherwise proven common law doctrines indeed, in a common law country

Discrimination and Efficiency in the Pricing of Public Goods

IT is widely accepted that public goods will generally be inadequately supplied and/or consumed if left to a private-pricing scheme (one in which the seller receives what the buyer pays). There are two cases to consider: one where exclusion is impossible or prohibitively expensive and the other where it is commercially feasible to practice selective exclusion. In the case of nonexclusion, the compelling argument against a private-pricing scheme is that no supply will be forthcoming, especially in large-number settings. Since each consumer can benefit from the public good that someone else pays for, the prevailing sentiment is to pretend no desire for the good and hope for a free ride. The problem is aggravated in the large-number case by the fact that each individual's share of the total benefit is small relative to cost. Therefore, the private supplier of the good will find little demand for his product at positive prices. While it is possible that these problems can be overcome through voluntary action, if the number of relevant decision makers is small, optimism on this score is undoubtedly misplaced in the vast majority of cases. When exclusion is commercially feasible-the case we will be concerned with throughout this paper-we can generally depend on private pricing to motivate a positive output of a public good.' When a person can be denied the benefit of a public good unless he pays a predetermined price, he ceases to realize any advantage from obscuring his demand for the good. In this