A Copernican View of Health Care Antitrust

Sage and Hammer use the analogy of Copernican astronomy to suggest that understanding the dramatic change wrought by managed care requires a conceptual reorientation regarding the meaning of competition in health care and its appropriate legal and regulatory oversight. Both share the belief that misperceiving the world limits potential for technical and social progress

Antitrust, Health Care Quality, and the Courts

Antitrust law represents the principal legal tool that the United States employs to police private markets, yet it often relegates quality and nonprice considerations to a secondary position. While antitrust law espouses the belief that vigorous competition will enhance quality as well as price, little evidence exists of the practical ability of courts to deliver on that promise. In this Article, Professors Hammer and Sage examine American health care as a vehicle for advancing understanding of the nexus among competition, quality, and antitrust law. The Article reports the results of a comprehensive empirical review of judicial opinions in health care antitrust litigation between 1985 and 1999, with specific attention to courts\u27 handling of quality and other nonprice concerns. Professors Hammer and Sage conclude that, although antitrust law cannot be expected to serve as the sole oversight mechanism for industries as complex and quality dependent as health care, courts have been successful incorporating some nonprice factors into antitrust analysis

Monopsony as an Agency and Regulatory Problem in Health Care

The article is organized as follows. Part I returns to the source, explaining the controversy in Kartell, examining Breyer\u27s opinion, and summarizing its impact on other courts. Part II looks at Kartell through the lens of classic monopsony theory involving suppliers, producers, and consumers, and focuses on the opinion\u27s oversimplification of the relationship between health insurers and insured individuals. It further considers whether lower input prices result in lower consumer prices in the endproduct market, and, therefore, whether monopsony power can be welfare-enhancing. Part III evaluates Kartell\u27s disregard of other important principal-agent problems in health care that arguably influence the welfare analysis of insurer conduct. It explores the degree to which group insurers stand in the shoes of individual consumers and the implications of non-insurer agency relationships, such as between physicians and patients. Part IV seeks to explain Kartell\u27s blind spots in regulatory terms and evaluates the implications of major changes in the structure and regulation of health insurance since 1980. The article contends that the reach and substantive content of antitrust law depend upon the regulatory environment in which alleged monopsony power is exercised, and asserts an important role for antitrust courts in the future

A Comparative Study on Graphene Oxide and Carbon Nanotube Reinforcement of PMMA-Siloxane-Silica Anticorrosive Coatings.

Carbon nanotubes (CNTs) and graphene oxide (GO) have been used to reinforce PMMA-siloxane-silica nanocomposites considered to be promising candidates for environmentally compliant anticorrosive coatings. The organic-inorganic hybrids were prepared by benzoyl peroxide (BPO)-induced polymerization of methyl methacrylate (MMA) covalently bonded through 3-(trimethoxysilyl)propyl methacrylate (MPTS) to silica domains formed by hydrolytic condensation of tetraethoxysilane (TEOS). Single-walled carbon nanotubes and graphene oxide nanosheets were dispersed by surfactant addition and in a water/ethanol solution, respectively. These were added to PMMA-siloxane-silica hybrids at a carbon (CNT or GO) to silicon (TEOS and MPTS) molar ratio of 0.05% in two different matrices, both prepared at BPO/MMA molar ratios of 0.01 and 0.05. Atomic force microscopy and scanning electron microscopy showed very smooth, homogeneous, and defect-free surfaces of approximately 3-7 μm thick coatings deposited onto A1020 carbon steel by dip coating. Mechanical testing and thermogravimetric analysis confirmed that both additives CNT and GO improved the scratch resistance, adhesion, wear resistance, and thermal stability of PMMA-siloxane-silica coatings. Results of electrochemical impedance spectroscopy in 3.5% NaCl solution, discussed in terms of equivalent circuits, showed that the reinforced hybrid coatings act as a very efficient anticorrosive barrier with an impedance modulus up to 1 GΩ cm(2), approximately 5 orders of magnitude higher than that of bare carbon steel. In the case of GO addition, the high corrosion resistance was maintained for more than 6 months in saline medium. These results suggest that both carbon nanostructures can be used as structural reinforcement agents, improving the thermal and mechanical resistance of high performance anticorrosive PMMA-siloxane-silica coatings and thus extending their application range to abrasive environments.This work was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Coordination for the Improvement of Higher Education Personnel (CAPES), and São Paulo Research Foundation (FAPESP)This is the author accepted manuscript. The final version is available from the American Chemical Society via http://dx.doi.org/10.1021/acsami.6b0478

Increased Trauma Activation Is Not Equally Beneficial For All Elderly Trauma Patients

Background Physiologic changes in the elderly lead to higher morbidity and mortality after injury. Increasing level of trauma activation has been proposed to improve geriatric outcomes; but, the increased cost to the patient and stress to the hospital system are significant downsides. The purpose of this study was to identify the age at which an increase in activation status is beneficial. Methods A retrospective review of trauma patients ≥ 70 years old from October 1, 2011, to October 1, 2016 was performed. On October 1, 2013, a policy change increased the activation criteria to the highest level for patients ≥ 70 years of age with a significant mechanism of injury. Patients who presented prior to (PRE) were compared to those after the change (POST). Data collected included age, injury severity score (ISS), length of stay (LOS), complications and mortality. Primary outcome was mortality and secondary outcome was LOS. Multivariable regressions controlled for age, ISS, injury mechanism, and number of complications. Results 4341 patients met inclusion criteria, 1919 in PRE and 2422 in POST. Mean age was 80.4 and 81 years in PRE and POST groups respectively (p=0.0155). Mean ISS values were 11.6 and 12.4 (p<0.0001) for the PRE and POST groups. POST had more level 1 activations (696 vs. 220, p<0.0001). After controlling for age, ISS, mechanism of injury, and number of complications, mortality was significantly reduced in the POST group ≥ age 77 years (OR 0.53, 95% CI: 0.3 - 0.87), (Figure 1). Hospital LOS was significantly reduced in the POST group ≥ age 78 (regression coefficient -0.55, 95% CI: -1.09, -0.01) (Figure 2). Conclusions This study suggests geriatric trauma patients ≥ 77 years benefit from the highest level of trauma activation with shorter LOS and lower mortality. A focused approach to increasing activation level for elderly patients may decrease patient cost. Level of Evidence Level III Type of Study Economic/Decisio

Protective Coatings Based on PMMA–Silica Nanocomposites Reinforced with Carbon Nanotubes

Polymethylmethacrylate–silica hybrids have been prepared using the sol–gel route by the radical polymerization of methyl methacrylate(MMA) using benzoyl peroxide (BPO) as a thermal initiator and 3-(trimethoxysilyl)propyl methacrylate(MPTS) as a coupling agent, followed by acid-catalyzed hydrolytic condensation of tetraethoxysilane (TEOS). Carbon nanotubes (CNTs) were first dispersed either by surfactant addition or by functionalization with carboxyl groups and then added at a carbon (CNT) to silicon (TEOS and MPTS) molar ratio (CCNT/SiHybrid) of 0.05% to two different hybrid matrices prepared at BPO/MMA molar ratios of 0.01 and 0.05. Films of 2–7 μm thickness deposited onto carbon steel by dip-coating were characterized in terms of their microstructure and their mechanical, thermal and anticorrosive behavior. Atomic force microscopy and optical microscopy confirmed that there was a homogeneous dispersion of CNTs in the nanocomposites and that the surfaces of the films were very smooth. X-ray photoelectron spectroscopy (XPS) confirmed the nominal composition of the films while nuclear magnetic resonance showed that the connectivity of the silica network was unaffected by CNT loading. Thermogravimetric analysis and mechanical measurements confirmed an increase of thermal stability, hardness, adhesion and scratch resistance of CNT-loaded coatings relative to those without CNTs. Electrochemical impedance spectroscopy measurements in 3.5% NaCl solution interpreted in terms of equivalent circuits showed that the reinforced hybrid coatings, prepared at the higher BPO/MMA molar ratio used in this work, act as a very efficient anticorrosive barrier, with an impedance modulus up to 109 Ω cm2

Simultaneous optical trapping and detection of atoms by microdisk resonators

We propose a scheme for simultaneously trapping and detecting single atoms near the surface of a substrate using whispering gallery modes of a microdisk resonator. For efficient atom-mode coupling, the atom should be placed within approximately 150nm from the disk. We show that a combination of red and blue detuned modes can form an optical trap at such distances while the backaction of the atom on the field modes can simultaneously be used for atom detection. We investigate these trapping potentials including van-der-Waals and Casimir-Polder forces and discuss corresponding atom detection efficiencies, depending on a variety of system parameters. Finally, we analyze the feasibility of nondestructive detection