Resale price maintenance and the limits of Article 101 TFEU: reconsidering the application of EU competition law to vertical price restraints

The public policy towards minimum resale price maintenance (‘RPM’), or vertical price fixing, namely the practice whereby a manufacturer stipulates a retail price floor below which its products are not to be resold, has traditionally been one of the most contentious antitrust issues on both sides of the Atlantic. Economic theory suggests that RPM is capable of producing ambivalent welfare consequences, thus obscuring the intellectual debate as to the optimal antitrust response to the practice. This normative uncertainty is best reflected in the divergent approach taken to RPM under the relevant laws of the United States and the European Union, arguably the world’s two most mature antitrust jurisdictions. In 2007, in its seminal Leegin judgment, the United States Supreme Court abolished the century-old per se ban on vertical price fixing. At the same time, under the European Commission’s recent Guidelines on Vertical Restraints price floors remain subject to a quasi-conclusive presumption of illegality. The purpose of this thesis is to examine whether a more consistent approach through the relaxation of the European Commission’s blanket prohibition on price floors would be feasible and, in effect, desirable. Based on insights from new institutional economics, it will be argued that RPM may on certain occasions be a substitute – however imperfect – for vertical integration, where a merger would be prohibitively costly for the parties, in which case the hierarchical form of organisation will have to be replaced by a hybrid governance structure. Under certain circumstances, a fixed retail profit margin may enhance the self-enforcing range of long-term partnerships governed by relational norms, as well as the manufacturer’s control over distribution by reducing substantially the transaction costs associated with monitoring dealer performance. At the same time, however, the analysis will take into account the various objections to the practice, most notably the horizontal collusion theory, in order to argue that the approach to RPM should in principle be cautious. The discussion will culminate in the proposal for a new, workable analytical framework for the substantive assessment of vertical price fixing under EU competition law, which will be based on a – genuinely – rebuttable presumption of anti-competitive object under Article 101(1) of the Treaty on the Functioning of the European Union

A Framework for the Quality Assurance of Blended E-Learning Communities

Abstract. E-learning enables learners to decide what to learn, when, how and how fast. In the blended e-learning paradigm, knowledge is delivered using a combination of online and traditional distant education practices. The purpose of this paper is to propose a set of criteria for the evaluation of the educational process in blended e-learning communities. The systematic surveying and evaluation of the various parameters that affect the educational outcome is the primary aim of the quality assurance process. Existing evaluation methods provide general guidelines, which fail to cover the traditional distant education procedures (e.g. educational material, sporadic face-to-face meetings) that accompany e-learning activities. The key reason for the success of a blended e-learning approach is the balance between computer based and face-to-face interactions and the harmonic merge of the two. First, we review the current quality evaluation models for education and focus on the criteria that apply to blended e-learning approaches. Then, we discuss the issues arising from the combination of the two alternatives and propose solutions for improving the quality of the whole process

Superior vena cava syndrome in a patient with previous cardiac surgery: what else should we suspect?

<p>Abstract</p> <p>Background</p> <p>Although mediastinal tumors compressing or invading the superior vena cava represent the major causes of the superior vena cava syndrome, benign processes may also be involved in the pathogenesis of this medical emergency. One of the rarest benign causes is a pseudoaneurysm developing in patients previously having heart surgery.</p> <p>Case report</p> <p>We present the case of a large pseudoaneurysm of the ascending aorta, five years after primary surgery, with a significant compression of the right mediastinal venous system causing superior vena cava syndrome, detected at chest CT angiography. Perioperative findings showed two rush out points both coming from the distal aortic suture line which was performed five years ago. The patient underwent reoperation under circulatory arrest facilitating safe exploration and repair of the distal anastomotic leaks</p> <p>Conclusion</p> <p>Enhanced chest CT should be always undertaken in all patients with superior vena cava syndrome, especially in those previously having cardiac or aortic surgery to correctly evaluate the presence of a pseudoaneurysm. Mass effect to the superior vena cava makes necessary an open surgical treatment of the pseudoaneurysm so as to concurrently resolve the right mediastinal venous system's compression. Surgery should be performed in terms of safe approach to avoid exsanguination and cerebral malperfusion.</p

Transternal repair of a giant Morgagni hernia causing cardiac tamponade in a patient with coexisting severe aortic valve stenosis

<p>Abstract</p> <p>Background</p> <p>Foramen of Morgagni hernias have traditionally been repaired by laparotomy, lapascopy or even thoracoscopy. However, the trans-sternal approach should be used when these rare hernias coexist with other cardiac surgical diseases.</p> <p>Case presentation</p> <p>We present the case of a 74 year-old symptomatic male with severe aortic <b>valve </b>stenosis and global respiratory failure due to a giant Morgagni hernia causing additionally cardiac tamponade. The patient underwent simultaneous repair of the hernia defect and aortic valve replacement under cardiopulmonary bypass. The hernia was repaired through the sternotomy approach, without opening of its content and during cardiopulmonary reperfusion.</p> <p>Conclusions</p> <p>Morgagni hernia can rarely accompany cardiac surgical pathologies. The trans-sternal approach for its management is as effective as other popular reconstructive procedures, <b>unless viscera strangulation and necrosis are suspected</b>. If severe compressive effects to the heart dominate the patient's clinical presentation correction during the cardiopulmonary reperfusion period is mandatory.</p

Oil prices, tourism income and economic growth: A structural VAR approach for European Mediterranean countries

In this study, a Structural VAR model is employed to investigate the relationship among oil price shocks, tourism variables and economic indicators in four European Mediterranean countries. In contrast with the current tourism literature, we distinguish between three oil price shocks, namely, supply-side, aggregate demand and oil specific demand shocks. Overall, our results indicate that oil specific demand shocks contemporaneously affect inflation and the tourism sector equity index, whereas these shocks do not seem to have any lagged effects. By contrast, aggregate demand oil price shocks exercise a lagged effect, either directly or indirectly, to tourism generated income and economic growth. The paper does not provide any evidence that supply-side shocks trigger any responses from the remaining variables. Results are important for tourism agents and policy makers, should they need to create hedging strategies against future oil price movements or plan for economic policy developments

Acute heart failure caused by a giant hepatocellular metastatic tumor of the right atrium

We present a symptomatic 40-year-old cirrhotic man who presented with sudden onsets of syncope. Echocardiography revealed right ventricular outflow track obstruction caused by a huge right atrial mass. The tumor was surgically excised under cardiopulmonary bypass. Although no primary cancerous lesion in the liver was detected, histopathology revealed that the mass was a metastatic hepatocellular carcinoma. The aim of this report is to show the value of urgent preoperative computed tomography and its contribution in the operative strategy. The importance of urgent surgical treatment with tricuspid valve sparing tumor resection is emphasized even though the prognosis for such patients is dismal. We also discuss the further management options of such rare case

Intimal aortic sarcoma mimicking ruptured thoracoabdominal type IV aneurysm. a rare case report and review of the literature

Primary intimal aortic sarcoma represents a very rare and highly lethal medical entity. Diagnosis is made either by embolic events caused by the tumor or by surrounding tissue symptoms such as pain. Herein we report an extremely rare case of a 51-year-old man previously operated for ascending aortic aneurysm, who presented with clinical and radiological findings suggestive of a ruptured thoracoabdominal type IV aneurysm. The patient underwent radical resection of the aorta and surrounding tissue with placement of a composite 4-branched graft. The diagnosis was made by frozen section and regular histopathologic examination of the specimen and the patient received adjuvant chemotherapy. Nine months after surgery the patient is still alive and has no signs of recurrence. We review the literature and discuss the option of postoperative chemotherapy

Beneficial effect of the oxygen free radical scavenger amifostine (WR-2721) on spinal cord ischemia/reperfusion injury in rabbits

<p>Abstract</p> <p>Background</p> <p>Paraplegia is the most devastating complication of thoracic or thoraco-abdominal aortic surgery. During these operations, an ischemia-reperfusion process is inevitable and the produced radical oxygen species cause severe oxidative stress for the spinal cord. In this study we examined the influence of Amifostine, a triphosphate free oxygen scavenger, on oxidative stress of spinal cord ischemia-reperfusion in rabbits.</p> <p>Methods</p> <p>Eighteen male, New Zealand white rabbits were anesthetized and spinal cord ischemia was induced by temporary occlusion of the descending thoracic aorta by a coronary artery balloon catheter, advanced through the femoral artery. The animals were randomly divided in 3 groups. Group I functioned as control. In group II the descending aorta was occluded for 30 minutes and then reperfused for 75 min. In group III, 500 mg Amifostine was infused into the distal aorta during the second half-time of ischemia period. At the end of reperfusion all animals were sacrificed and spinal cord specimens were examined for superoxide radicals by an ultra sensitive fluorescent assay.</p> <p>Results</p> <p>Superoxide radical levels ranged, in group I between 1.52 and 1.76 (1.64 ± 0.10), in group II between 1.96 and 2.50 (2.10 ± 0.23), and in group III (amifostine) between 1.21 and 1.60 (1.40 ± 0.19) (p = 0.00), showing a decrease of 43% in the Group of Amifostine. A lipid peroxidation marker measurement ranged, in group I between 0.278 and 0.305 (0.296 ± 0.013), in group II between 0.427 and 0.497 (0.463 ± 0.025), and in group III (amifostine) between 0.343 and 0.357 (0.350 ± 0.007) (p < 0.00), showing a decrease of 38% after Amifostine administration.</p> <p>Conclusion</p> <p>By direct and indirect methods of measuring the oxidative stress of spinal cord after ischemia/reperfusion, it is suggested that intra-aortic Amifostine infusion during spinal cord ischemia phase, significantly attenuated the spinal cord oxidative injury in rabbits.</p

The Investigation of RIS/PACS Information Systems’ Incorporation in Greek Public Hospitals: Results from a National Web-based Survey

Purpose: The objective of this study is to assess the current level of Radiological Information Systems (RIS) and Picture Archiving and Communication Systems (PACS) incorporation in greek public hospitals through a national web-based survey. Since there are no previous studies on this field of medical imaging management in Greece, we look forward to export useful conclusions about RIS/PACS incorporation and set the foundation for further investigation. Material and Methods: A comprehensive measurement instrument that integrates the existing theoretical and empirical literature knowledge on Information Systems (IS) evaluation was properly modified and used for the purpose of this study. A web-based survey was conducted via Google Form questionnaire, which was distributed to the entire population of radiologists and radiologic technologists (potential users) of all greek public hospitals (urban and rural), in order to identify the availability of RIS/PACS Information Systems (IS), the level of incorporation through system’s impact on users satisfaction and their operating capacities (i.e. computerized activities and processes). Results: A total of 49 valid responses out of 77 collected questionnaires were received from all 124 greek public hospitals, which represents a response rate of 39.5%. Our very first findings indicate that establishment of RIS/PACS has not been fulfilled so far for the vast majority of greek public hospitals. Almost half of the participants (51%) responded that they use only the capabilities of PACS as a repository for medical images, instead of implementing all capabilities of RIS. Also, although 85.7% of the participants responded that they use disc publisher for medical imaging exams copies, only 6.1% responded that has gone totally filmless or paperless. 59.2% of the respondents has access to 5 or more workstations and 100% of the respondents agrees that ER and clinics should connect on hospital's RIS/PACS for viewing medical images, receiving electronic reports and updating patients' electronic files. Overall findings from statistical techniques demonstrate a statistically significant difference in perceived information (p-value=0.021) and service quality (p-value=0.036) with age of respondents. Finally, open feedback answers indicate that greek public hospitals have still many to set to successfully incorporate and exploit the wide range of RIS/PACS capabilities to improve quality, effectiveness and efficiency of patient care services. Discussions: Although, most of the respondents have an adequate level in the operation of information systems, lack of RIS/PACS usage training is noted, as well as users’ support from their own organization IT staff. Also, structural deficiencies worry system’s users, making them intolerant to adopting the system in daily practice. The recommendations of this study include RIS/PACS incorporation in every medical imaging department of greek hospitals, users training and support, as well as updating infrastructures where needed