\u3cem\u3eMessner\u3c/em\u3e\u27s Effect on Hospital Consolidation and Anticompetitive Behavior

By 2021, healthcare spending is expected to reach a whopping twenty percent of gross domestic product. One of the less-publicized causes of the rapid growth in healthcare costs is hospital consolidation, which has allowed hospitals to use their market power to raise prices for private payors. Attempts to limit abuses of market power in this sector have been insufficient. From the 1980s until the early 1990s, the Federal Trade Commission and the Department of Justice blocked every anticompetitive merger. However, the tides changed in the mid-1990s when the regulators lost five successive cases that challenged hospital mergers. Economists were astounded by these rulings as the defendants relied on unsuitable models to successfully argue that the regulators\u27 definition of their geographic markets was too limited. Empowered by these rulings, hospitals consolidated rapidly. Only recently have better economic models demonstrated that hospital consolidation causes price increases. The Federal Trade Commission\u27s case against Evanston Northwestern Healthcare Corporation applied these new economic models. In this case, the health network acquired a nearby hospital to form Northshore University HealthSystem. The FTC won its case, and after the administrative action, a class action was filed against Northshore. The district court denied certification, and the plaintiffs appealed. The Seventh Circuit ultimately certified the class in Messner v. Northshore University HealthSystem. This Note explores whether the Seventh Circuit\u27s decision in Messner will deter hospitals\u27 anticompetitive conduct in light of the Court\u27s Daubert ruling and trends in antitrust class actions and finds that it will ultimately be in the hands of the regulators to police hospitals\u27 monopolistic practices

\u3cem\u3eMessner\u3c/em\u3e\u27s Effect on Hospital Consolidation and Anticompetitive Behavior

By 2021, healthcare spending is expected to reach a whopping twenty percent of gross domestic product. One of the less-publicized causes of the rapid growth in healthcare costs is hospital consolidation, which has allowed hospitals to use their market power to raise prices for private payors. Attempts to limit abuses of market power in this sector have been insufficient. From the 1980s until the early 1990s, the Federal Trade Commission and the Department of Justice blocked every anticompetitive merger. However, the tides changed in the mid-1990s when the regulators lost five successive cases that challenged hospital mergers. Economists were astounded by these rulings as the defendants relied on unsuitable models to successfully argue that the regulators\u27 definition of their geographic markets was too limited. Empowered by these rulings, hospitals consolidated rapidly. Only recently have better economic models demonstrated that hospital consolidation causes price increases. The Federal Trade Commission\u27s case against Evanston Northwestern Healthcare Corporation applied these new economic models. In this case, the health network acquired a nearby hospital to form Northshore University HealthSystem. The FTC won its case, and after the administrative action, a class action was filed against Northshore. The district court denied certification, and the plaintiffs appealed. The Seventh Circuit ultimately certified the class in Messner v. Northshore University HealthSystem. This Note explores whether the Seventh Circuit\u27s decision in Messner will deter hospitals\u27 anticompetitive conduct in light of the Court\u27s Daubert ruling and trends in antitrust class actions and finds that it will ultimately be in the hands of the regulators to police hospitals\u27 monopolistic practices

The Legislative History of Mental Disorders in Federal Education Programs

In recent years, the diagnosis of mental disorders in school age children such as Attention Deficit Disorder (ADD), Attention-Deficit/Hyperactivity Disorder (ADHD), Early Onset Bipolar Disorder (EOBD), and Oppositional Defiant Disorder (ODD) have increased as a percentage of the total school population. This paper looks at the development of federal education policies based on legislation that includes the Elementary and Secondary Education Act, No Child Left Behind, and the recent Every Student Succeeds Act. It also includes the development of federal education policies through legislation regarding students with disabilities. Terms related to the diagnosis of childhood mental disorders will be defined as recorded in the Diagnostic and Statistical Manual (DSM), published by the American Psychiatric Association. The paper considers how the changes to the DSM over time have affected the meanings of the mental disorders that can be found in subsequent iterations of federal and state law. This paper analyzes the implementation of school sanctioned and/or recommended or prescribed treatments for the identified disorders. It looks at the results of the implementation of these prescriptions and/or treatments over time and the perceived results related to the next steps in federal and state legislation regarding mental and behavioral health polices for students

Social media and social mobilisations : tensions between articulation and visibility

El artículo analiza los usos de los medios sociales en las movilizaciones sociales y su transición hacia espacios sostenidos de participación social. Basado en estudio de casos múltiple de movilizaciones sociales recientes, se realiza un análisis del discurso de las narrativas asciadas a estos episodios de acción colectiva. Se analizan tres dimensiones principales: 1) referencias a la democracia, en particular las críticas a la democracia representativa y alternativas propuestas; 2) comentarios acerca del rol de los medios sociales en la movilización y su devenir; y 3) reflexiones sobre las tensiones entre las dimensiones online y offline de la acción colectiva.The article aims to examine the uses of social media by social mobilisation and their transition towards social movements. Based on a multiple case study of recent social mobilisations, a discourse analysis was conducted to compare uses of social media in the narratives associated with these social mobilisations. Three main dimensions were analysed: 1) references to democracy, in particular criticisms of representative democracy and proposals for alternatives; 2) comments on the role of social media in social mobilisation and its development; and 3) reflections on tensions between online and offline actions as part of collective action

Territorialidade e sociabilidade nos movimentos sociais latino-americanos: uma aproximação ao estudo do MST do Brasil e do MOCASE da Argentina

Des-territorialization has been one of the dimensions for the analyses of globalization processes in current societies, mainly from the identity-cultural dimension of the phenomenon. A multiple case study of two Latin American social movements ―particularly those acting from rural context― shows the articulations between the counter-hegemony processes of appropriation of territoriality developed as part of the collective action. These links, as well as the diverse mediations mediating them, demonstrate the complexity of the new senses of territoriality created by these social movements, which overcome the property and the spatial dimension and are directly connected with processes of social change. We conclude that there is, in the both movements analyzed, a mutual and complex mediation between appropriation of territorialities and emergence of new sociabilities, in an articulation mediated by dimensions such as communication and rituals.La (des)territorialización ha sido uno de los principales ejes de análisis en torno a los procesos globalizadores en las sociedades contemporáneas, sobre todo en aproximaciones a la cuestión desde sus dimensiones cultural-identitarias. Este artículo, basado en un estudio de casos de movimientos sociales latinoamericanos ligados al contexto rural, discute las articulaciones entre los procesos contrahegemónicos de apropiación de la territorialidad y las dinámicas de emergencia de una nueva socialidad que se desarrollan como parte de la acción colectiva. Estos vínculos, así como las diversas mediaciones que los atraviesan, evidencian la complejidad de los nuevos sentidos de la territorialidad configuradas por estos movimientos, no limitados a la cuestión propietario-espacial, sino que apuntan a proyectos de cambio social. Se concluye que  en los movimientos analizados hay una mediación mutua y compleja entre apropiación de territorialidades y emergencia de nuevas socialidades, en una articulación intermediada por dimensiones como la comunicación y la ritualidad.A (des)territorialização tem sido um dos principais eixos analíticos sobre os processos globalizantes nas sociedades contemporâneas, especialmente em aproximações que consideram as dimensões culturais e identitárias. Este artigo, baseado em um estudo de casos de movimentos sociais latino-americanos ligados ao contexto rural, discute as articulações entre os processos contra-hegemônicos de apropriação da territorialidade e as dinâmicas de emergência de uma nova sociabilidade desenvolvida como parte da ação coletiva. Estes vínculos, bem como as mediações intrínsecas aos mesmos, evidenciam a complexidade dos novos sentidos da territorialidade configuradas por estes movimentos, não limitados à questão proprietário-espacial, mas configurados ao redor de projetos de mudança social. Conclui-se que nos movimentos analisados existe uma mediação mutua e complexa entre apropriação de territorialidade e emergência de novas sociabilidades, em uma articulação intermediada por dimensões como a comunicação e o ritual

"Places making": Construcción participada de ciudades de cultura científi ca

In the framework of the European project Platform of Local Authorities and Communicators Engaged in Science (PLACES), we analyse the articulations between scientifi c communication, public perception of science, processes of citizen participation and apropiation of space, based on a case study of the inhabitants of Teruel city, Autonomous Community of Aragon, Spain. On the interrelationships between these issues, there are a number of contradictions, such as the difference between a high interest for information about science and technology and a low level of recognition and interaction with local institutions involved in those activities, the complex conceptualization of scientifi c space in relation to the “public-private” pair, or an articulation of a claiming civic rethoric and an insuffi cient co-responsibility. We conclude that, in a local context, the dimension of territoriality and, in particular, the identifi cation with the town, is a central mediation for activating citizen participation as part of processes of appropriation of space for setting up cities of scientifi c culture.En el marco del proyecto europeo Platform of Local Authorities and Communicators Engaged in Science (PLACES), se analizan las articulaciones entre comunicación científica, percepción pública de la ciencia, procesos de participación ciudadana y apropiación del espacio, a partir de un estudio de caso de los habitantes de la ciudad de Teruel, en la Comunidad Autónoma de Aragón, España. En las interrelaciones entre tales cuestiones, se ponen de manifiesto una serie de contradicciones, como la diferencia entre un elevado interés informativo por temas de ciencia y tecnología y un bajo nivel de reconocimiento e interacción con las instituciones locales vinculadas a aquellos, la dual y compleja conceptualización de los espacios científicos en relación con el par “público-privado”, o la coexistencia de una retórica cívica reivindicativa junto con una escasa corresponsabilidad. Se concluye que, en un contexto local, la dimensión de la territorialidad y en particular la identificación con la localidad, es una mediación central en la activación de la participación ciudadana activa como parte de procesos de apropiación del espacio para la configuración de ciudades de cultura científica

Heregulin Activity Assays for Residual Testing of Cell Therapy Products

Background: Heregulin is a ligand for the protooncogene product ErbB/HER that acts as a key mitogenic factor for human Schwann cells (hSCs). Heregulin is required for sustained hSC growth in vitro but must be thoroughly removed before cell collection for transplantation due to potential safety concerns. The goal of this study was to develop simple cell-based assays to assess the effectiveness of heregulin addition to and removal from aliquots of hSC culture medium. These bioassays were based on the capacity of a β1-heregulin peptide to elicit ErbB/HER receptor signaling in adherent ErbB2+/ErbB3+ cells. Results: Western blotting was used to measure the activity of three different β1-heregulin/ErbB-activated kinases (ErbB3/HER3, ERK/MAPK and Akt/PKB) using phospho-specific antibodies against key activating residues. The duration, dose-dependency and specificity of β1-heregulin-initiated kinase phosphorylation were investigated, and controls were implemented for assay optimization and reproducibility to detect β1-heregulin activity in the nanomolar range. Results from these assays showed that the culture medium from transplantable hSCs elicited no detectable activation of the aforementioned kinases in independent rounds of testing, indicating that the implemented measures can ensure that the final hSC product is devoid of bioactive β1-heregulin molecules prior to transplantation. Conclusions: These assays may be valuable to detect impurities such as undefined soluble factors or factors for which other biochemical or biological assays are not yet available. Our workflow can be modified as necessary to determine the presence of ErbB/HER, ERK, and Akt activators other than β1-heregulin using native samples, such as fresh isolates from cell- or tissue extracts in addition to culture medium.Fil: Monje, Paula. Indiana University. School Of Medicine.; Estados UnidosFil: Bacallao, Ketty. Miami University. School Of Medicine; Estados UnidosFil: Aparicio, Gabriela Inés. Universidad Nacional de San Martín. Instituto de Investigaciones Biotecnológicas. - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Biotecnológicas; Argentina. Indiana University. School Of Medicine.; Estados UnidosFil: Lalwani, Anil. Cell and Gene Therapy CMC and Regulatory Advisor; Estados Unido

Improved Shape Parameter Estimation in Pareto Distributed Clutter with Neural Networks

The main problem faced by naval radars is the elimination of the clutter input which is a distortion signal appearing mixed with target reflections. Recently, the Pareto distribution has been related to sea clutter measurements suggesting that it may provide a better fit than other traditional distributions. The authors propose a new method for estimating the Pareto shape parameter based on artificial neural networks. The solution achieves a precise estimation of the parameter, having a low computational cost, and outperforming the classic method which uses Maximum Likelihood Estimates (MLE). The presented scheme contributes to the development of the NATE detector for Pareto clutter, which uses the knowledge of clutter statistics for improving the stability of the detection, among other applications

Occludin Content Modulates Hydrogen Peroxide–Induced Increase in Renal Epithelial Paracellular Permeability

The ability of hydrogen peroxide (H2O2) to increase paracellular permeability of renal epithelial cell monolayers was examined and the role of occludin in this regulation was investigated. H2O2 treatment increased the paracellular movement of calcein, a marker for the leak pathway permeability, across monolayers of two renal epithelial cell lines, MDCK and LLC-PK1, in a concentration-dependent manner. At the same concentrations, H2O2 did not alter transepithelial resistance (TER) nor increase cell death. The magnitude of the H2O2-induced increase in leak pathway permeability was inversely related to cellular occludin protein content. H2O2 treatment did not produce any major change in total cellular content or Triton X-100-soluble or -insoluble fraction content of occludin protein. Occludin protein staining at the tight junction region was diminished following H2O2 treatment. The most dramatic effect of H2O2 was on the dynamic mobility of GFP-occludin into the tight junction region. H2O2 treatment slowed lateral movement of GFP-occludin into the tight junction region but not on the apical membrane. Further, removal of the cytoplasmic C-terminal region of occludin protein eliminated the effect of H2O2 on GFP-occludin lateral movement into the tight junction region. An increase in the mobile fraction of GFP-occludin was associated with a loss of response to H2O2. These data indicate that the H2O2-induced increase in renal epithelial cell paracellular permeability is mediated, at least in part, through occludin protein, possibly through a slowing of the rate of occludin movement into the tight junction region