Defending hospital mergers after the FTC's unorthodox challenge to the Evanston Northwestern--Highland Park transaction

Examining the Federal Trade Commission's retrospective challenge of a hospital merger in Illinois, the author provides an insightful analysis of one of the agency's major antitrust enforcement initiatives in health care in the last several years. Because the case produced several departures from antitrust orthodoxy, these departures may affect the trials of future hospital mergers that are challenged. The author reviews the methodology and evidence of the case, and he identifies theories and best practices that are important for administrators and legal practitioners to implement in future mergers.     

Assessment and management of risk for intimate partner violence by police officers using the Spousal Assault Risk Assessment Guide

Intimate partner violence (IPV) is a crime that is present in all countries, seriously impacts victims, and demands a great deal of time and resources from the criminal justice system. The current study examined the use of the Spousal Assault Risk Assessment Guide, 2nd ed. (SARA; Kropp, Hart, Webster, & Eaves, 1995), a structured professional judgment risk assessment and management tool for IPV, by police officers in Sweden over a follow-up of 18 months. SARA risk assessments had significant predictive validity with respect to risk management recommendations made by police, as well as with recidivism as indexed by subsequent contacts with police. Risk management mediated the association between risk assessment and recidivism: High levels of intervention were associated with decreased recidivism in high risk cases, but with increased recidivism in low risk cases. The findings support the potential utility of police-based risk assessment and management of IPV, and in particular the belief that appropriately structured risk assessment and management decisions can prevent violence.     

Age estimation in children by measurement of open apices in tooth roots: Study of a Mexican sample

The aim of this cross-sectional study was to test the accuracy of Cameriere's European formula for age assessment in a large sample of Mexican children. The accuracy of dental age estimation was defined as how closely real age, measured as the difference between chronological age (CA) and dental age (DA), could be predicted. Digitalized orthopantomographs of 502 Mexican children (254 girls and 248 boys), aged between 5 and 15 years, were analyzed. The seven left permanent mandibular teeth were evaluated using Cameriere's method. Intra- and inter-observer variability for this technique was tested on a small random sample. Dental age was estimated for each individual and compared with known chronological age. Accuracy was measured as the difference between known chronological age and dental age and tested for significance with the mean prediction error (ME). The standard deviation and 95% confidence interval of the mean difference were also calculated. ME was 0.63 years for girls and 0.52 years for boys. ME was found to be slightly overestimated by 0.10 years for girls, but was correctly estimated for boys with an accuracy of 0.00. In conclusion, this method is very useful and may be recommended for practical application both in clinical dentistry and forensic procedures on the Mexican population.     

Influence of CYP2D6 genotype on the disposition of the enantiomers of venlafaxine and its major metabolites in postmortem femoral blood

Venlafaxine (VEN) is an antidepressant drug mainly metabolized by the cytochrome P450 (CYP) enzyme CYP2D6 to the active metabolite O-desmethylvenlafaxine (ODV). VEN is also metabolized to N-desmetylvenlafaxine (NDV) via CYP3A4. ODV and NDV are further metabolized to N,O-didesmethylvenlafaxine (DDV). VEN is a racemic mixture of the S- and R-enantiomers and these have in vitro displayed different degrees of serotonin and noradrenaline reuptake inhibition. The aim of the study was to investigate if an enantioselective analysis of VEN and its metabolites, in combination with genotyping for CYP2D6, could assist in the interpretation of forensic toxicological results in cases with different causes of deaths. Concentrations of the enantiomers of VEN and metabolites were determined in femoral blood obtained from 56 autopsy cases with different causes of death. The drug analysis was done by liquid chromatography tandem mass spectrometry (LC/MS/MS) and the CYP2D6 genotyping by PCR and pyrosequencing. The mean (median) enantiomeric S/R ratios of VEN, ODV, NDV and DDV were 0.99 (0.91), 2.17 (0.93), 0.92 (0.86) and 1.08 (1.03), respectively. However, a substantial variation in the relationship between the S- and R-enantiomers of VEN and metabolites was evident (S/R ratios ranging from 0.23 to 17.6). In six cases, a low S/R VEN ratio (mean 0.5) was associated with a high S/R ODV ratio (mean 11.9). Genotyping showed that these individuals carried two inactive CYP2D6 genes indicating a poor metabolizer phenotype. From these data we conclude that enantioselective analysis of VEN and ODV can predict if a person is a poor metabolizer genotype/phenotype for CYP2D6. Knowledge of the relationship between the S- and R-enantiomers of this antidepressant drug and its active metabolite is also important since the enantiomers display different pharmacodynamic profiles.     

Salaried lawyers and billable hours: a new perspective from the sociology of work

The work of legal professionals is changing rapidly, but the changes have not yet been thoroughly investigated from the perspective of the sociology of work. This paper draws on a research project that examined the work of solicitors in private practice in Melbourne, Australia. It uses in-depth interviews, results of secondary surveys and other data sources in order to describe the dominant working-time patterns. The evidence points to a common pattern of rigid and demanding schedules, which can be traced back to the indirect pressures exerted by the widespread system of ‘billable hours’. The paper takes up the challenge to examine the operation of this system. We argue that the billable hours system, initially just a technique for billing clients, has been transformed into a tool for measuring and controlling the work of salaried solicitors, through setting of targets, close time recording, careful monitoring, and a supple set of sanctions.     

Good Faith and the Ubiquity of the ‘Relational’ Contract

The judgment of Leggatt J in Yam Seng Pte Ltd v International Trade Corporation Ltd shows the common belief that the English law of contract does not have a doctrine of good faith to be mistaken. That law does not have a general principle of good faith, but its doctrine of good faith, articulated through numerous specific duties, is more suitable for the interpretation of contracts according to the intentions of the parties than a general principle which invites the imposition of exogenous standards. That Yam Seng involved a relational contract does not mean that paternalistic exogenous standards should be imposed. It means that the good faith obligations essential even to a commercial contract of this sort must be implied in order to give efficacy to the fundamentally co‐operative contractual relationship.     

Participation and commitment in third-party research funding: evidence from Italian Universities

Over the last few years, the emergence of universities’ third mission has significantly affected objectives, sources of funding and financing methods, as well as the management, of universities. Although the university–industry relationships have been widely investigated, several interesting theoretical and empirical issues still remain open in the literature. In this paper we construct an original data set, combining financial information with structural and organizational data on Italian University departments, with a twofold aim. First, to describe the importance and the extent of third-party funding in the Italian system of research as well as the pattern of evolution over the last few years. Second, to investigate the factors that influence both the probability and the intensity of the commitment of departments in third-party activities by building a multi-level framework combining factors at individual, departmental, university and territorial levels. The results obtained suggest a number of policy implications for universities and policy makers. On one hand, universities should explicitly recognize the role of dedicated internal organizations and provide training for professional staff capable of acting as value-added intermediaries. On the other hand, if policy makers wish to improve the relationships between universities and external actors, disciplinary differences across departments as well as regional inequalities in growth levels should be carefully considered, giving up a one-size-fits-all approach.     

Is Representation Enough? Racial Disparities in Levels of Force and Arrests by Police

The research in representative bureaucracy that examines the extent to which racial congruence impacts bureaucrats’ decisions is mixed. This study adds to this literature by examining the impact of representative bureaucracy on the level of force that police officers use and whether they make an arrest in use of force encounters, while taking into consideration key situational conditions. Using individual-level data from New Orleans to estimate this impact, the authors find that racial congruence and incongruence impact policing outcomes even in the presence of situational shortcuts that cue decision-making. The findings show that the benefits of representation are conditional on the outcome. Black officers are less likely to use higher levels of force on Black civilians. Yet both Black and White officers are less likely to arrest White civilians in use of force encounters. This suggests that interactions in which bureaucrats have less discretion (e.g., arrests) may offer limited opportunities for active representation.