Seeking a Clearer Picture: Assessing the Appropriate Regulatory Framework for Broadband Video Distribution

This Note examines the appropriate regulatory framework for the distribution of commercial video content over broadband networks. As online video providers such as Netflix and Hulu expand, they are beginning to compete directly with the video services of major cable and telecommunications companies. Frequently, these companies also serve as a customer’s Internet service provider, leaving them in the position of carrying these competitive services over their broadband networks. This conflict has led to calls for regulation that would protect nascent online video services from feared anticompetitive actions by the major providers. In April 2010, against the backdrop of this expanding conflict, the U.S. Court of Appeals for the D.C. Circuit in Comcast Corporation v. FCC dealt a blow to the Federal Communications Commission’s (FCC) ability to regulate in this arena. There, the circuit court invalidated the FCC’s jurisdictional approach to regulating broadband Internet. Although the FCC has subsequently reasserted its jurisdiction over broadband, the fallout from Comcast has rekindled debates as to whether broadband is best governed by proscriptive FCC regulation, or whether oversight of this marketplace should be left to the general antitrust authorities—the Department of Justice and the Federal Trade Commission. This Note discusses the jurisdictional challenges to broadband oversight faced by each agency, and assesses the substantive and procedural merits of FCC and antitrust governance regimes. It then argues that, given the uncertainty regarding its authority, the FCC should abandon its efforts to regulate broadband video distribution in the absence of clear market harms. Finally, this Note proposes that this dynamic and rapidly evolving marketplace should develop outside the bounds of proscriptive regulations, with antitrust serving as a backstop if market intervention proves necessary

Cardiovascular mortality in liver and kidney transplant recipients

Previous studies have demonstrated cardiovascular causes to be among the leading causes of death after liver (LT) and kidney transplantation (KT). Although both recipient populations have unique pre-transplant cardiovascular burdens, they share similarities in post-transplant exposure to cardiovascular risk factors. The aim of this study was to compare cardiovascular mortality after LT and KT.We analyzed causes of death in 370 consecutive LT and 207 KT recipients from in-hospital records at a single tertiary transplant center. Cardiovascular causes of death were defined as cardiac arrest, heart failure, pulmonary embolism, or myocardial infarction.After a median follow-up of 36.5 months, infection was the most common cause of death in both cohorts, followed by cardiovascular causes in KT recipients and graft-related causes in LT recipients in whom cardiovascular causes were the third most common. Cumulative incidence curves for cardiovascular mortality computed with death from other causes as the competing risk were not significantly different (P = .36). While 1-year cumulative cardiovascular mortality was similar (1.6% after LT and 1.5% after KT), the estimated 4-year probability was higher post-KT (3.8% vs. 1.6%). Significant pre-transplant risk factors for overall mortality after KT in multivariable analysis were age at transplantation, left ventricular ejection fraction <50%, and diastolic dysfunction grade 2 or greater, while significant risk factors for cardiovascular mortality were peripheral artery disease and left ventricular ejection fraction <50%. In the LT group no variables remained significant in a multivariable model for either overall or cardiovascular mortality.The present study found no significant overall difference in cardiovascular mortality after LT and KT. While LT and KT recipients may have similar early cardiovascular mortality, long-term risk is potentially lower after LT. Differing characteristics of cardiovascular death between these two patient populations should be further investigated

NAFLD and liver transplantation: Current burden and expected challenges

Because of global epidemics of obesity and type 2 diabetes, the prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing both in Europe and the United States, becoming one of the most frequent causes of chronic liver disease and predictably, one of the leading causes of liver transplantation both for end-stage liver disease and hepatocellular carcinoma. For most transplant teams around the world this will raise many challenges in terms of preand post-transplant management. Here we review the multifaceted impact of NAFLD on liver transplantation and will discuss: (1) NAFLD as a frequent cause of cryptogenic cirrhosis, end-stage chronic liver disease, and hepatocellular carcinoma; (2) prevalence of NAFLD as an indication for liver transplantation both in Europe and the United States; (3) the impact of NAFLD on the donor pool; (4) the access of NAFLD patients to liver transplantation and their management on the waiting list in regard to metabolic, renal and vascular comorbidities; (5) the prevalence and consequences of post-transplant metabolic syndrome, recurrent and de novo NAFLD; (6) the alternative management and therapeutic options to improve the long-term outcomes with particular emphasis on the correction and control of metabolic comorbidities