Sheep in Wolves’ Clothing? The Book the Han Nationalists Love to Loath

What book could cause one Chinese netizen to “shiver with fear from head to toe” and others to suggest that the Han people might once again face genocide? Wolf Totem (狼图腾), the semi-autobiographical polemic of Han author Lü Jiamin 吕嘉民 (aka Jiang Rong 姜戎) and his confessional self-awakening about the beauty, strength and freedom of the Mongolian steppe and its lupine culture

Achieving Value in Spine Surgery: 10 Major Cost Contributors.

STUDY DESIGN: Narrative Review. OBJECTIVES: The increasing cost of healthcare overall and for spine surgery, coupled with the growing burden of spine-related disease and rising demand have necessitated a shift in practice standards with a new emphasis on value-based care. Despite multiple attempts to reconcile the discrepancy between national recommendations for appropriate use and the patterns of use employed in clinical practice, resources continue to be overused-often in the absence of any demonstrable clinical benefit. The following discussion illustrates 10 areas for further research and quality improvement. METHODS: We present a narrative review of the literature regarding 10 features in spine surgery which are characterized by substantial disproportionate costs and minimal-if any-clear benefit. Discussion items were generated from a service-wide poll; topics mentioned with great frequency or emphasis were considered. Items are not listed in hierarchical order, nor is the list comprehensive. RESULTS: We describe the cost and clinical data for the following 10 items: Over-referral, Over-imaging & Overdiagnosis; Advanced Imaging for Low Back Pain; Advanced imaging for C-Spine Clearance; Advanced Imaging for Other Spinal Trauma; Neuromonitoring for Cervical Spine; Neuromonitoring for Lumbar Spine/Single-Level Surgery; Bracing & Spinal Orthotics; Biologics; Robotic Assistance; Unnecessary perioperative testing. CONCLUSIONS: In the pursuit of value in spine surgery we must define what quality is, and what costs we are willing to pay for each theoretical unit of quality. We illustrate 10 areas for future research and quality improvement initiatives, which are at present overpriced and underbeneficial

Bundled Payment Models in Spine Surgery.

STUDY DESIGN: The following is a narrative discussion of bundled payments in spine surgery. OBJECTIVE: The cost of healthcare in the United States has continued to increase. To lower the cost of healthcare, reimbursement models are being investigated as potential cost saving interventions by driving incentives and quality improvement in fields such a spine surgery. METHODS: Narrative overview of literature pertaining to bundled payments in spine surgery synthesizing findings from computerized databases and authoritative texts. RESULTS: Spine surgery is challenging to define payment modes because of high cost variability and surgical decision-making nuances. While implementing bundled care payments in spine surgery, it is important to understand concepts such as value-based purchasing, episodes of care, prospective versus retrospective payment models, one versus two-sided risk, risk adjustment, and outlier protection. Strategies for implementation underscore the importance of risk stratification and modeling, adoption of evidence based clinical pathways, and data collection and dissemination. While bundled care models have been successfully implemented, challenges facing institutions adopting bundled care payment models include financial stressors during adoption of the model, distribution of risks, incentivization of treating only low risk patients, and nuanced variation in procedures leading to variation in costs. CONCLUSION: An alternative for fee for service payments, bundled care payments may lead to higher cost savings and surgeon accountability in a patient\u27s care

Sheldon Spectrum and the Plankton Paradox: Two Sides of the Same Coin : A trait-based plankton size-spectrum model

The Sheldon spectrum describes a remarkable regularity in aquatic ecosystems: the biomass density as a function of logarithmic body mass is approximately constant over many orders of magnitude. While size-spectrum models have explained this phenomenon for assemblages of multicellular organisms, this paper introduces a species-resolved size-spectrum model to explain the phenomenon in unicellular plankton. A Sheldon spectrum spanning the cell-size range of unicellular plankton necessarily consists of a large number of coexisting species covering a wide range of characteristic sizes. The coexistence of many phytoplankton species feeding on a small number of resources is known as the Paradox of the Plankton. Our model resolves the paradox by showing that coexistence is facilitated by the allometric scaling of four physiological rates. Two of the allometries have empirical support, the remaining two emerge from predator-prey interactions exactly when the abundances follow a Sheldon spectrum. Our plankton model is a scale-invariant trait-based size-spectrum model: it describes the abundance of phyto- and zooplankton cells as a function of both size and species trait (the maximal size before cell division). It incorporates growth due to resource consumption and predation on smaller cells, death due to predation, and a flexible cell division process. We give analytic solutions at steady state for both the within-species size distributions and the relative abundances across species

Progress and prospects for event tourism research

This paper examines event tourism as a field of study and area of professional practice updating the previous review article published in 2008. In this substantially extended review, a deeper analysis of the field’s evolution and development is presented, charting the growth of the literature, focusing both chronologically and thematically. A framework for understanding and creating knowledge about events and tourism is presented, forming the basis which signposts established research themes and concepts and outlines future directions for research. In addition, the review article focuses on constraining and propelling forces, ontological advances, contributions from key journals, and emerging themes and issues. It also presents a roadmap for research activity in event tourism

Contrasting perspectives of strategy making: applications in 'Hyper' environments

We revisit the original meaning of turbulence in the socioecological tradition of organization studies and outline a perspective on strategy making grounded in that tradition. This entails a contrast of the socioecological perspective with the more well-known neoclassical perspective on strategy, based on their core decision premises and their different understandings of environmental turbulence. We argue that while some mainstream strategy approaches have taken important strides toward addressing advanced turbulence, many others remain tethered to the neoclassical origins of the strategy discipline and are insufficiently responsive to the new landscape of strategy that now characterizes many industries. This new landscape is construed as the ‘hyper environment’, in which positive feedback processes and emergent field effects produce high volatility. We use two case illustrations from the US healthcare sector to examine how neoclassical and socioecological perspectives contribute to strategizing in hyper environments. Implications for strategic management theory and practice flow from this analysis

Digital Chinese Whispers: Death Threats and Rumors Inside China’s Online Marketplace of Ideas

The Chinese internet is a wonderfully raucous and interesting place. It has greatly expanded the scope of public discourse and activity, despite the party-state’s extensive censorship regime. Not surprisingly, the world’s largest cyber-community exhibits tremendous depth and diversity: progressive cyber-activists and professional agitators; navel-gazing starlets and steam-venting gamers; mundane infotainment and the banal waxing of quotidian life; and, sadly, dark corners of fear, hatred and paranoia. It’s all there; it simply depends on where one looks. Like other technologies before it, the internet is normatively neutral, and thus can be put to good, bad and anodyne uses: individuals—not tools—shape the contours of different societies and their cultures