bluuebunny/crossref_metadata_2025 huggingface dataset:
Capacity Reservations at Interconnectors: An Analysis under EU Competition and EU Energy Law
Authors: Karova Rozeta
Published: February 2017

This article analyzes the capacity reservation at interconnectors as regulatory measures adopted by the EU Member States and the Contracting Parties of the Energy Community Treaty. These measures will be examined under competition rules as well as under energy law. Even though these measures are adopted with the legitimate goal of ensuring security of supply, they infringe upon the non-discrimination principle and jeopardize the cross-border trade and the establishment of regional electricity markets. Finally, this article analyzes the possible justification under PSO provision, in case these measures do not fall under competition law, because they are attributable to the state in question, and if they satisfy the strict conditions provided under Article 3 of Directive 2003/54/EC.
On the Role of International Benchmarking of Electricity Transmission System Operators Facing Significant Investment Requirements
Authors: Brunekreeft Gert
Published: February 2017

Electricity networks currently face massive investment requirements. This paper argues that, given the investment requirements, (international) benchmarking is not an adequate tool for the regulation of transmission system operators (TSO). Errors in the outcomes of benchmarking will likely distort network investment and therefore the costs of doing it wrong are high. Whilst acknowledging the merits of network regulation as such, the paper discusses options to reduce the weight of benchmarking in TSO regulation and discusses options that do not rely on benchmarking at all.
The Interface between Competition Rules and Sector-Specific Regulation in the Telecommunications Sector: Evidence from Recent EU Margin Squeeze Cases
Authors: Colangelo Margherita
Published: February 2017

In recent decades the relationship between competition law and regulation has become a very controversial issue, in particular in respect of the interface between competition rules and sector-specific regulation in liberalized network industries. The article examines the controversial practice of margin squeeze, engaging in a detailed analysis of the relevant US and EU case-law in regulated industries in order to conduct a tentative critical exploration of these respective approaches and to consider whether a reconciliation between such regimes is possible. Moreover, it aims at examining some relevant open issues related to price squeeze, particularly with regard to the concurrent application of competition rules and sector-specific regulation and the risks connected with the coexistence of different sets of rules and also of different competent authorities.
2012 Framework on Public Compensation for SGEIs: Application in the Postal Sector
Authors: Geradin Damien , Malamataris Christos
Published: February 2017

The legal rules applicable to State compensation for services of general economic interest (“SGEIs”) were recently revised by the European Commission. This led to the adoption of the “2012 SGEI Package”. The most contentious document of this Package, the “2012 Framework”, sets out the conditions for the compatibility of SGEI compensation with the internal market. Against this background, the Commission has recently shown an increased interest in the application of the State aid rules to the postal sector and seems determined to continue scrutinizing the sector in the future. This article aims to analyse the specific rules of the Framework and look closer at the way they (could) apply to the postal sector, with references to the decisional practice of the Commission.
Implementing Incentive Regulation and Regulatory Alignment with Resource Bounded Regulators
Authors: Glachant Jean-Michel , Khalfallah Haikel , Perez Yannick , Rious Vincent , Saguan Marcelo
Published: February 2017

It is puzzling today to explain both the diversity and the rationale of regulators' practice vis-à-vis network monopolies. We argue that two fundamental characteristics should be considered when defining the most appropriate regulatory tools. First, it is the bounded endowment of regulators set by governments and legislators which determines their abilities (staff, budget, administrative powers) to implement any of the regulatory tools. Ranked from the easiest to the most demanding to implement, these various tools are: a- cost plus, b- price/revenue cap, c- output or performance-based regulation, d- menu of contracts and e- yardstick competition. Second, the regulators also have to take into account that the network monopolies perform multiple tasks with heterogeneous regulatory characteristics (in terms of controllability, ex ante predictability and ex post observability). These characteristics of tasks determine what type of regulatory tool is more likely to better regulate each task. The regulatory tools then perform well only when they are implemented for tasks that are controllable and predictable enough. It is the kind of observability of these tasks which determines the best incentive tool to implement. Lastly, conclusions for the regulation of networks are derived. A workable regulation of network relies on a reasonable alignment of the regulatory tools with the regulatory characteristics of tasks and the regulators resource endowment.
Looking towards Europe: Regulation of Dominance in Nigerian Telecommunications
Authors: Opata Chukwudiebube Bede Abraham
Published: February 2017

Nigeria is yet to enact generally applicable competition laws. However, in the telecommunications sector, sector-specific competition rules were enacted with the regulator taking steps including determination of dominance in selected markets to enforce these rules. These developments are important in Nigeria as they could provide good domestic references for future application of both general competition law in Nigeria and sector-specific application of competition rules in other network industries in the country. Furthermore, with regulatory determinations of dominance relatively rare in national communications sectors of African countries, Nigerian regulatory decisions are likely to be of interest to operators and regulators in other countries within the Sub-Saharan Africa region.

This article critically analyzes regulation of dominant positions in the Nigerian telecommunications sector. It identifies the relevant legal provisions on dominant positions in Nigerian telecommunications and shows that while the Nigerian Communications Commission's (NCC) approach in this area appears to be influenced by European Union (EU) law, the Nigerian rules have developed and are applied in a way different from the application of comparable EU rules. Furthermore, the article also identifies a need for revision of the applicable regulations to stipulate the basis for market selection and refine criteria for identification of the relevant market for purposes of dominance analysis. The article further identifies specific issues with the NCC's application of criteria for single dominance assessment including; an apparent misapplication of the market shares criterion; very little of the NCC's assessment is backed by available data and supporting evidence; and the entire assessment focused on application of its six criteria to the retail aspects of the mobile markets with the wholesale market is completely ignored.

With regards to International Internet Connectivity market, this article argues that NCC's decision to rely only on ex-post regulatory intervention in line with the practice in other jurisdictions failed to appreciate the differences in the legal basis for regulatory action between Nigeria and the EU for instance. The EU has separate provisions for sector-specific ex ante regulation and general ex post competition laws, while Nigeria only has sector-specific prescriptive regulations governing dominant positions. This entails that reliance only on as yet nonexistence ex post basis for regulatory intervention would leave Nigerian service providers without a remedy.
Italian Regulation of Electricity Distribution and its Impact on Efficiency, Investments and Innovation: A Qualitative Assessment
Authors: Benedettini Simona , Pontoni Federico
Published: February 2017

The increase in distributed generation and the pro-active role of consumers call for smarter networks. Consequently, regulation must change to promote this evolution. This article performs a critical overview of the Italian regulation of electricity distribution and its effectiveness in encouraging efficiency, quality and innovative investments. The analysis shows that the regulator has followed a building-block approach: throughout different regulatory periods, it has added new modules to its previous regulatory mechanism to take care of the constantly increasing set of objectives. This does not give DSOs a unitary and coherent regulatory framework and has led to the overlapping of different incentive mechanisms.
The Cost of Equity of Network Operators – Empirical Evidence and Regulatory Practice
Authors: Schaeffler Stephan , Weber Christoph
Published: February 2017

In many European countries, the deregulation of energy markets made the task of setting an adequate cost of equity more difficult. The question arises, how regulators set equity returns for network operators and whether the methodologies applied are in line with state-of-the-art capital market models. Based on an analysis of empirical results published and an own data set of more than 20 network operators, we show that most regulatory agencies do not set interest rates in an optimal way. Firstly, they either include companies with other systematic risk (e.g. integrated utilities) in their datasets. Secondly, they rely solely on CAPM even if the use of a size factor can potentially increase quality of results. The article concludes by providing a suggestion on how to put the FF TFM into practice accounting for the size of non-stock listed network operators.
Postal Services Liberalization in Turkey: Observations and Reflections
Authors: Emek Uğur
Published: February 2017

With a view to promoting competition and improving consumer welfare, postal markets have been liberalized in many jurisdictions over recent years. The present study intends to review liberalization movements in postal services with a particular focus on Turkey. Although Turkey has long before embarked upon reform initiatives to liberalize network industries, the (state-owned) incumbent is one of last comers to meet competitive conditions in postal markets. Recently a new Postal Services Law has been enacted in the country in order to develop a well-designed regulatory structure, to delegate a regulatory agency, to limit the scope of the incumbent's reserved area, to determine standards and financing means of the provision of the universal service, to define licensing and operation conditions, and last but not least to specify principles of tariffs among others. The article concludes that despite crucial shortcomings such as continuation of the postal monopoly, and lack of ex ante regulations regarding third party access to the (monopolistic) incumbent's postal network, introducing competition into postal services is prima facie a positive step towards the improvement of efficiency and so the enhancement of users' prosperity.
The Challenges of Imperfectly Unbundled TSOs: Can Corporate Governance or Regulatory Action Mitigate Such Imperfection?
Authors: d'Arcy Anne , Finger Matthias
Published: February 2017

This article provides a framework for analyzing the effects of imperfect ownership unbundling and the effectiveness of related corporate governance mechanisms as well as regulatory actions to mitigate against such effects in the case of operators of an electricity transmission grid, i.e., so-called Transmission System Operators (TSOs). We propose a matrix analysis that considers three main tasks of a TSO (as one dimension) for different unbundling scenarios (as the other dimension). We apply the matrix for analyzing the case of the Swiss TSO Swissgrid as a special form of imperfect unbundling. Based on a task based welfare analysis, we argue that full ownership unbundling is optimal for certain strategic decisions such as the transfer of the grid from old to new owners. In some cases, corporate governance mechanisms, no matter how sophisticated, will not solve conflicts of interest within an imperfectly unbundled electricity firm. Also, in some cases, regulatory action cannot mitigate such imperfection. In contrast, we find no evidence that operations suffer from this lack in corporate governance. Insofar, trade-offs arise between different degrees of unbundling.
Corporate Governance and the State
Authors: Mueller Dennis C.
Published: February 2017

Pick up any first-year textbook in economics, and you will see that the analysis of pricing and other decisions by firms is based on the assumption that they maximize profits. More generally, when economists talk about the advantages of market economies – invisible hands and the like – they are implicitly assuming that managers maximize profits or shareholder wealth. Some 80 years ago, Berle and Means (1932) called this assumption into question by documenting the existence of a separation of ownership and control. Their main concern was that this separation of ownership from control would free managers to essentially rob the owners of the firm. The recent histories of firms like Enron, WorldCom, and Parmalat show that such fears remain well founded even today.

The existence of a separation of ownership from control potentially gives rise to a host of principal/agent problems, which go beyond managers simply stealing from shareholders. I begin by discussing some of these as they manifest themselves in the private sector, turn after that to state-controlled companies, and end with a discussion of corporate governance problems in regulated industries.
Water, Sanitation and Intergovernmental Relations in Italy after WWII: A Case Study on Milan's Water and Sanitation Service
Authors: Reghizzi Olivier Crespi
Published: February 2017

This paper focuses on the case of Milan's water and sanitation service in the second half of the 20th century, in the wider legislative and regulatory context of Italian Water and Sanitation Services (WSS). We discuss the evolution of intergovernmental financial relations in Italy. We also analyze the water and sanitation regulatory context, the financing tools available and the constraint on water prices due to national regulation driven by anti-inflation policies. We look into Milan's water sanitation service focusing on three key issues: a) how were public service mission goals implemented? b) Were the costs covered by revenues endogenous or exogenous to the water and sanitation service? And c) what is the long run cost allocation? Who did pay in fine for the infrastructure? Our analysis is based on an original dataset collected from the yearly financial report of Milan's municipality.
From Denationalisation to Wholesale Broadband Access: A Retrospective of Regulatory Policies in the UK for the Communications Industry
Authors: Deshpande Advait , Jones Allan
Published: February 2017

This paper examines the shifting regulatory policies in the United Kingdom (UK) across three market segments, telecommunications, radio/television and cable, starting with British Telecom's (BT's) denationalisation in 1984. For the period examined, this paper focuses on following key events – – The phased liberalisation of the UK communications industry starting with the BT-Mercury Communications duopoly in 1984 – The allocation of cable franchises as regional monopolies in the mid-1980s – Introduction of satellite broadcasting and the influence of British Sky Broadcasting (BSkyB) Corp. on broadcasting services in the 1990s – The emergence of the Internet/Web and the subsequent development of a broadband policy from mid-1990s onwards

Drawing on Dodgson et al.'s concepts of Market logic, Coordination Logic, and Complex-Evolutionary Logic, the authors argue that the forms of regulation introduced shaped the ways the UK communications industry developed. Thus although the denationalisation grew out of a free market ideology, in practice the free market philosophy was tempered for a number of pragmatic reasons. Prominent among these was a need to create a competitive market in a context where competitors would be unlikely to emerge without regulatory intervention, and an emphasis on price competitiveness to ensure that the end-users benefitted from the best possible prices on available products and services. Subsequent events show that these interventions had unintended consequences. The unforeseen popular demand for Internet/Web access found regulators struggling to find ways to promote a competitive market, and incumbent operators struggling to find a way to offer a suitable product.
Regional Energy Strategy as a Guideline for Novel Regulation Process
Authors: Ropuszynska-Surma Edyta , Weglarz Magdalena
Published: February 2017

There are two main ideas in this paper: (a) regional-sector strategy could be created by a ‘bottom-up’ planning process and (b) the foresight methodology (and especially the mix of its methods) are the support tools for the regulation process on the regional level. We base our work on previous experiences and on the results of the research project named ‘Energy Development Strategy for Lower Silesia by Using Foresight Methods’ and carried out by our team from Wroclaw University of Technology (Poland). First of all, we present the idea of regulation in economies and the ‘bottom-up’ approach in programming regional development in the energy sector. The next part of the article concerns the key issues of foresight methodology and the range of its use. The results of our project are presented in the last part of this paper. The main idea is to show how foresight methods and main experts' methods, e.g. the Delphi method, can successfully support a ‘bottom up’ approach.
Mergers and Telecommunications Infrastructure Deployment
Authors: Majumdar Sumit K. , Moussawi Rabih , Yaylacicegi Ulku
Published: February 2017

We retrospectively evaluate the impact of the various mergers of the local exchange companies in the United States telecommunications industry between 1988 and 2001 on technology investment levels. We use treatment effects modeling to evaluate major mergers in a sector where technology diffusion is important, and the approach accounts for selection bias and the endogenous nature of mergers. Our framework is based on behavioral theories of the firms and we use co-evolutionary and dynamic capabilities approaches in framing our analyses and explaining our results. We find that across firms and time, the merger events are positively and significantly associated with investments in fiber and digital assets. We stratify the data by size of firm to undertake detailed data analysis because of the presence of firm-specific heterogeneities and find that for the smaller merging firms there is a negative and significant association of mergers with investments in fiber and digital assets while for the larger merging firms this mergers and fiber and digital assets investments association is positive and significant. Our results support the predictions of the behavioral theories of the firm, and particularly the dynamic capabilities perspective. We draw implications for theory and competition policy of our results.
Merger between Airlines in Financial Distress
Authors: Zhang Yahua
Published: February 2017

The merger in 2009 between China Eastern Airlines and Shanghai Airlines came at a time when both airlines were suffering heavy losses and were struggling for survival during the global financial crisis. An examination of the prices on China Eastern's seven domestic Shanghai-based routes suggests that on average fares on departure days increased by 22% post-merger. It appears that the merger conferred China Eastern with significant market power owing to the parallel nature of this acquisition, thereby resulting in the record profit reported in 2010. This reminds regulatory authorities to remain vigilant in handling airline mergers when numerous parallel routes are involved.
Principles of Good Supervision and the Regulation of the Dutch Drinking Water Sector
Authors: Lavrijssen Saskia , Vitez Blanka
Published: February 2017

In March 2014, the OECD issued a report in which it indicated that the Netherlands “has an excellent track record on water management in several areas”. The OECD mentions for example that the Netherlands has developed a “strong economy and robust water industry”, this despite that 55% of the Netherlands' territory is below sea level. However, the OECD also concluded that Dutch water governance “relies on a system of many checks and balances … [and] that system presents some limitations.” In response to the conclusion of the OECD, this article discusses the current framework of economic regulation of the Dutch drinking water sector. The article develops a normative framework to assess whether the current organization of economic regulation is adequate. The assessment examines to which extent the principles of good regulation are observed by economic regulation of the drinking water sector. It is concluded that the Dutch framework of economic regulation of the drinking water sector displays several weaknesses in light of the principles of good regulation. In particular, the principles of transparency and independency need better observance. As a result the protection of the interests of the users of drinking water is at stake. This article ends with some recommendations to enhance the quality of economic regulation of the Dutch drinking water sector.
Vertical Unbundling and the Coordination of Investment in Electric Systems
Authors: Brunekreeft Gert , Friedrichsen Nele
Published: February 2017

This paper addresses the investment coordination problem in a vertically separated electricity supply industry in the absence of locational pricing. In an electricity system, investments in network and power plants need to be coordinated. Unbundling eliminates firm-internal coordination. Information exchange might restore coordination if communication is truthful. Based on model results we analyse whether cheap talk of generator investors would be credible and hence informative for network investment decisions. We show that due to perverse incentives, this is not generally the case. We propose cost-reflective, locational network pricing as a coordination device to internalize the incentive problem.
Are Institutions Conducive to Better Regulatory Environment in Infrastructure?
Authors: Sumkoski Goran
Published: February 2017

This empirical research tests the hypothesis that the institutional factors are important for achieving regulatory environment in infrastructure that is conducive to increased investment and output in a developing country such as Bangladesh. Data is obtained from ICRG, WGI and infrastructure regulation indicators from OECD database as well as from a set of uniquely reconstructed infrastructure regulatory indicators for energy, telecommunications, transport for Bangladesh for the period from 1975 to 2013 to exactly mirror the scope and depth of OECD dataset and to enable comparison. The results confirm that institutional factors such as accountability, corruption, efficiency, property rights, bureaucratic quality are conducive to better regulatory environment and positively affect infrastructure regulation in both OECD countries and in a developing country such as Bangladesh.
A Process Perspective on Regulation
Authors: Ubacht Jolien
Published: February 2017

The transition from a former monopolistic towards a more competitive market in newly liberalized network-based markets raises regulatory issues. National Regulatory Authorities (NRA) face the challenge to deal with these issues in order to guide the transition process. Although this transition process is widely studied, an integral view on the regulatory process itself remained absent. This raises the research question how NRAs deal with the regulatory issues while aiming for competition engineering. By following a Grounded Theory approach we analyzed the regulatory practice of three NRAs in newly liberalized mobile telecommunications markets during a five-year period. Our study reveals a high variety in procedural activities that represent the complexity of the regulatory process. Insight into these activities is informative for regulatory processes that need to determine the appropriate governance arrangements in complex, dynamic markets in which the institutions and technology go through a continuous co-evolutionary process. Firmly based in empirical data we present the theoretical concept of mixing and matching which represents the way in which activities are mixed during the regulatory process and matched with the issue that requires a governance arrangement. Further research into regulatory practice in other newly liberalized network-based markets will lead to a formal theory of regulatory practice as a process. This study contributes to the domain of regulatory studies by focusing on the procedural aspects of regulatory practice in newly liberalized network-based markets.
Calling vs. Receiving Party Pays
Authors: Majer Tommaso , Pistollato Michele
Published: February 2017

We provide a theoretical framework to analyse how the level of mobile termination rates (MTRs) affects market penetration. We compare market penetration and welfare between the Calling Party Pays (CPP) and the Receiving Party Pays (RPP) regimes. In addition to that, we provide policy recommendations to the regulator when choosing the level of the MTRs. Our results suggest that market penetration and welfare depend on the size of the call externalities (i.e. the utility that consumers obtain from receiving a call). With large call externalities, a Bill&Keep arrangement (i.e. MTRs set at zero, which is usually associated to RPP tariff regimes) implies higher usage and higher market penetration. This is because higher usage increases the utility of joining a mobile network, and consequently, more people would like to join a network.
How Do Network Companies Seek Legitimacy for Public Value Trade Offs?
Authors: Steenhuisen Bauke , de Bruijne Mark
Published: February 2017

Network companies fulfill a critical role in the energy transition. This article provides an empirical study of this role of a Dutch national gas network company connecting a biogas producer. This project requires choices about many intertwined technical and institutional variables. Choices involve multiple, potentially competing public values like safety, cost-efficiency, sustainability and non-discrimination. A formal governance structure provides generic guidelines for network companies about how to act in the public interest, but we argue that unclarity remains on how to trade-off public values. In these instances, a network company seeks legitimacy for the choices that are made. Via an in-depth case study on the injection of biogas we explored how a network company interpreted its public role and how public value trade-offs were made. We conclude that legitimacy is sought and found in a mixture of formal and informal ways both inside the network company as well as outside. Although the governance regime allowed the network company to take a leading role in the innovative project, it failed as a starting point to claim legitimacy. These findings provide food for thought on how to institutionally embed the role of network companies in the energy transition.
Retail Price Regulation in the British Energy Industry
Authors: Crampes Claude , Laffont Mathias
Published: February 2017

In this paper, we revisit the 2009–2012 episode in which Ofgem imposed a nondiscrimination clause on large retailers in the UK energy market. The Standard Licence Condition 25A (SLC 25A) was introduced to prevent suppliers from charging their incumbent customers higher prices than their out-of-area customers. The SLC 25A included a “sunset clause”, to allow the condition to lapse three years after its implementation. Several IO economists protested that the prohibition of spatial price discrimination would eventually lead to competition weakening. At the end of the three-year period, Ofgem decided not to renew SLC 25A for any period. To further our understanding of Ofgem's motives and its opponents' arguments, we build a model where two local monopolists compete on a third market. We determine conditions where the obligation to set the same price in and out of the local market can result in a better or a worse situation for consumers. We show that even when the ban on price discrimination weakens competition, the average consumer can be better off.
The Online Transportation Network in Indonesia: A Pendulum between the Sharing Economy and Ex Ante Regulation
Authors: Wahyuningtyas Sih Yuliana
Published: February 2017

The prominent role of innovation in the emerging digital market in Indonesia presents new challenges for current competition law and policy. Traditionally reliant on market definition for the analysis, the present competition law may not yet have sufficiently taken innovation into consideration. In the competition policy area, while innovation has not taken a clear role in tailoring suitable regulations or approaches, markets have attempted to adapt themselves to the new changes in order to meet rising demand. The present state of policy is illustrated by the development oj online transportation networks like those provided by Uber and GrabCar, services similar to those that have been traditionally offered by taxi companies. While regulation asymmetry has been accused of not allowing a level playing field for conventional taxis versus online transportation networks, the concept of the sharing economy seems to address today's policy approach in Indonesia, which favors ex ante regulation on public transportation service provision in the country. This paper examines the applicable regulations in the transportation network industry and discusses how competition policy might cope with this issue and in what cases competition law might deal with innovation brought by online transportation network in the public transportation industry in Indonesia.
Incidence and Etiology of Sudden Cardiac Death: New Updates for Athletic Departments
Authors: Asif Irfan M. , Harmon Kimberly G.
Published: February 2017

Context:

Sudden cardiac death (SCD) in a young athlete is a tragic event and is the leading medical cause of death in this population. The precise incidence of SCD in young athletes has been subject of debate, with studies reporting drastically different rates (1:917,000 athlete-years (AYs) to 1:3000 AYs) depending on the methodological design of the investigation or the targeted population.

Evidence Acquisition:

A literature search was performed in PubMed using the terms: incidence, sudden cardiac death, sudden death, sudden cardiac arrest, etiology, pathology, registry, athlete, young, children, and adolescents. Articles were reviewed for relevance and included if they contained information on the incidence of SCD in athletes or young persons up to the age of 35 years.

Study Design:

Clinical review.

Level of Evidence:

Level 5.

Results:

Studies of high quality and rigor consistently yield an incidence of 1:50,000 AYs in college athletes and between 1:50,000 and 1:80,000 AYs for high school athletes, with certain subgroups that appear to be at particularly high risk, including the following: men, basketball players, and African Americans. Initial reports suggest that the most common cause of SCD is hypertrophic cardiomyopathy (HCM). However, more comprehensive investigations in the United States and international populations—athletes, nonathletes, and military—support that the most common finding on autopsy in young individuals with SCD is actually a structurally normal heart (autopsy-negative sudden unexplained death).

Conclusion:

SCD is the leading cause of death in athletes during exercise and usually results from intrinsic cardiac conditions that are triggered by the physiologic demands of vigorous exercise. Current rates of SCD appear to be at least 4 to 5 times higher than previously estimated, with men, African Americans, and male basketball players being at greatest risk. Emerging data suggest that the leading finding associated with SCD in athletes is actually a structurally normal heart (autopsy-negative sudden unexplained death).
Atypical antipsychotics: recent research findings and applications to clinical practice: Proceedings of a symposium presented at the 29th Annual European College of Neuropsychopharmacology Congress, 19 September 2016, Vienna, Austria
Authors: Murray Robin , Correll Christoph U. , Reynolds Gavin P. , Taylor David
Published: February 2017

Available evidence suggests that second-generation atypical antipsychotics are broadly similar to first-generation agents in terms of their efficacy, but may have a more favourable tolerability profile, primarily by being less likely to cause extrapyramidal symptoms. However, atypical antipsychotics are variably associated with disturbances in the cardiometabolic arena, including increased body weight and the development of metabolic syndrome, which may reflect differences in their receptor binding profiles. Effective management of schizophrenia must ensure that the physical health of patients is addressed together with their mental health. This should therefore involve consideration of the specific tolerability profiles of available agents and individualization of treatment to minimize the likelihood of adverse metabolic sequelae, thereby improving long-term adherence and optimizing overall treatment outcomes. Alongside this, modifiable risk factors (such as exercise, diet, obesity/body weight and smoking status) must be addressed, in order to optimize patients’ overall health and quality of life (QoL). In addition to antipsychotic-induced side effects, the clinical management of early nonresponders and psychopharmacological approaches for patients with treatment-resistant schizophrenia remain important unmet needs. Evidence suggests that antipsychotic response starts early in the course of treatment and that early nonresponse accurately predicts nonresponse over the longer term. Early nonresponse therefore represents an important modifiable risk factor for poor efficacy and effectiveness outcomes, since switching or augmenting antipsychotic treatment in patients showing early nonresponse has been shown to improve the likelihood of subsequent treatment outcomes. Recent evidence has also demonstrated that patients showing early nonresponse to treatment with lurasidone at 2 weeks may benefit from an increase in dose at this timepoint without compromising tolerability/safety. However, further research is required to determine whether these findings are generalizable to other antipsychotic agents.
Nomad self-governance and disaffected power versus semiological state apparatus of capture: The case of Roma Pentecostalism
Authors: Voiculescu Cerasela
Published: February 2017

Inspired by Deleuze and Guattari, the article discusses Roma Pentecostalism as nomad self-governance or self-ministry and political affirmation, in a dialectical conversation with stable apparatuses of power such as state and transnational polities advancing a neoliberal program of social integration as semiological apparatus of capture. The latter is upheld by expert social sciences as royal sciences, which translate alternative forms of self-governance into the conceptual apparatus of the state and transnational polities. On the other hand, Pentecostal self-ministry works as disaffected power undoing the architecture of the state subject, authorizing new hermeneutics of the self to take control over semiological acts of translation, and engenders a political resubjectivation of the governed. The article identifies Roma Pentecostalism as a source of political reawakening of Romani civil society, a creative line of flight with an immense power of deterritorialization of the main domains of subjection.
Novel biomarkers for the detection of prostate cancer
Authors: Jakobsen Niels Asger , Hamdy Freddie Charles , Bryant Richard John
Published: February 2017

Prostate-specific antigen (PSA) is widely used as a biomarker in the detection of prostate cancer and for decision making regarding treatment options, response to therapy, and clinical follow-up. Despite its widespread use, it is well recognised that PSA has suboptimal performance as a screening tool due to poor specificity, resulting in high negative biopsy rates and potential ‘over-diagnosis’ and ‘over-treatment’ of clinically insignificant cancers. In particular, PSA does not reliably distinguish either cancer from benign prostatic conditions, or ‘clinically significant’ from ‘indolent cancers’, and it is inaccurate in predicting disease burden and response to treatment. There is an urgent demand for novel biomarkers to address these clinical needs. This article provides an update on the novel candidate biomarkers in development, which have shown potential for improving the detection of clinically significant cases of this malignancy.
Calcineurin Inhibitors in the Treatment of Primary Focal Segmental Glomerulosclerosis
Authors: Laurin Louis-Philippe , Nachman Patrick H. , Foster Bethany J.
Published: February 2017

Purpose of review:

Primary focal segmental glomerulosclerosis (FSGS) is the most common cause of nephrotic syndrome in adults. Glucocorticoids have been evaluated in the treatment of primary FSGS in numerous retrospective studies. Evidence suggesting a role for including calcineurin inhibitors (CNIs) in early therapy remains limited. The aim of this study was to systematically review the literature examining the efficacy of CNIs in the treatment of primary FSGS both as first-line therapy and as an adjunctive agent in steroid-resistant patients, with respect to remission in proteinuria and renal survival.

Sources of information:

PubMed and EMBASE were searched from inception to August 2014 for prospective controlled trials, and case-control and cohort studies.

Findings:

After systematically applying our inclusion criteria, a total of 152 titles and abstracts were identified. Six randomized controlled trials and 2 cohort studies were reviewed. Three randomized controlled trials compared CNIs with placebo or supportive therapy. The pooled relative “risk” of proteinuria remission associated with cyclosporine was 7.0 (95% confidence interval, 2.9-16.8) compared with placebo/supportive therapy. There was very low heterogeneity among these studies with an I-squared of 0%. Three studies compared CNIs with another immunosuppressive agent. All prospective trials were conducted in patients with primary FSGS deemed steroid-resistant.

Limitations:

The relatively small number of included studies and their heterogeneity with respect to treatment protocols, and possible publication bias, limit conclusions drawn from this systematic review.

Implications:

The efficacy of CNIs has been evaluated in steroid-resistant primary FSGS patients. There is no evidence supporting their role as first-line therapy. Further studies are needed to determine this role.
Global Versus Domain-Specific Identity Processes
Authors: Vosylis Rimantas , Erentaitė Rasa , Crocetti Elisabetta
Published: February 2017

The current study contributes to the ongoing discussion about validity and utility of global and domain-specific assessment of identity processes in emerging adulthood (EA) by using a three-dimensional model of identity development and examining four identity domains (best friend, education, occupation, and partner). The links between global and domain-specific identity processes and main features of EA are analyzed in the Eastern European context, which is largely underrepresented in studies on identity development. Participants were 1,217 (49.9% females) emerging adults aged between 20 and 31 years ( Mage = 25.89, SDage = 3.51). This study showed that global identity processes only partly explain domain-specific ones and that domain-specific processes have unique links with features of EA. Taken together, this study shows that consideration of different life domains to measure identity processes is essential, since identity development in friendship, partnership education, and work domains can have different associations with outcomes of interest.
Free Flap Failures: What to Do Next?
Authors: Afridi Nadia S , Paletz Jl , Morris Sf
Published: February 2017

Over the past two decades, microvascular free tissue transfer has become a common procedure, usually with predictable results. The overall success rate of free flap surgery has gradually improved, and most recent reviews document an overall success rate between 90% and 95%. The goal of this study was to determine the outcome of those patients who underwent unsuccessful free microvascular tissue transfer. An extensive chart review was carried out on all those patients who underwent free microvascular tissue transfer at the Queen Elizabeth II Health Sciences Centre from 1988 to 1999. One hundred and forty-eight patients underwent free tissue transfer. A total of 164 free flaps were carried out, with an overall success rate of 92%. Free flap failure was defined as complete necrosis of the flap. There were 13 documented flap failures with complete necrosis of the flap requiring debridement. Seven patients underwent repeat free microvascular tissue transfer. These procedures were carried out by the same surgeon or surgical team 12 to 52 days after the first surgery. These secondary microvascular procedures were all successful. Of the remaining patients, five had either debridement and split-thickness skin grafting or regional flap coverage. One patient went on to lower limb amputation. This study reaffirms the success rates of free microvascular tissue transfer. In addition, the success rates of repeat free flaps were evaluated. It appears that patients undergoing repeat microvascular tissue transfers have no innate propensity for flap failure.
Long Term Effects of the Latham Presurgical Maxillary Orthopedic Appliance, Including Effects on Tooth Growth
Authors: Samson Michel C , Lalonde Donald H , Fitzpatrick Donald , Sparkes Gerald L
Published: February 2017

Reported beneficial effects of presurgical maxillary orthopedics in cleft lip include reduction of the cleft width, alignment of the maxillary segments, elevation of the alar base on the cleft side, diminished need for alveolar bone grafting and lip closure without tension. Possible adverse effects of presurgical maxillary orthopedics include tooth root damage and inability of periosteoplasty to make bone over the cleft. A series of wide cleft lip patients (n=15) treated with the Latham appliance at the time of lip closure were retrospectively compared with a similar group treated without the Latham appliance. The Latham appliance group (seven unilateral clefts, eight bilateral clefts; mean follow-up 9.5 years; range four to 18 years) was treated between the years 1980 and 1994. None of the 15 patients treated with the appliance had any tooth loss or damage attributable to the pins, and bone formation in the alveolar cleft was observed radiographically in all 13 of the patients who had a periosteoplasty at the time of lip repair, possibly obviating the need for secondary bone grafting. Five of these Latham group patients demonstrated clinical and radiographic evidence of tooth eruption into the periosteoplasty-formed bone. There was no consistent difference in the level of nasal alar base elevation in the two groups.
No Vertical Scar Breast Reduction: A Good Alternative to the T-SCAR Inferior Pedicle Breast Reduction
Authors: Lalonde Donald H
Published: February 2017

Techniques of the no vertical scar breast reduction, as used in more than 65 patients for over three years, are detailed. This technique is basically the same as the standard inferior pedical T-scar technique, except that the verticle scar is eliminated. Refinements of the technique include avoiding the ‘armpit’ breast; creating tension-free periareolar suturing with a small areolar hole; knowing how to perform the technique when there is only 3 cm of skin between the areola and the new areola position; and applying the same technique to mastopexy.
Reformers in Medical Education and Practice
Authors: Entin Martin A
Published: February 2017

Background

The standards of professional practice are constantly shifting to keep pace with acquired knowledge. When the standards fell short of professional expectations, when the practising physician became more concerned with financial gain than effective patient care, society needed a reformer to evaluate the process and to improve it.

Study Design

Individual physicians and scientists were selected from throughout the history of medicine until the end of the 18th century, who conformed to our definition of reformers, namely, a person who changed the structure or ideology of medical practice.

Results

This survey demonstrates that reforms are produced by persons whose minds possess analytical quality and critical judgment. Reformers have influenced the directions of medical practice and teaching.

Conclusion

The improvement in medical practice has been achieved through intuitive leaps, rejection of conventional practice, painstaking research or administrative restructuring.
Novel Approach in the Evaluation of Flap Failure Using near Infrared Spectroscopy and Imaging
Authors: Abdulrauf Badr M , Stranc Miroslaw F , Sowa Michael G , Germscheid Shelley L , Mantsch Henry H
Published: February 2017

Methods of tissue viability assessment should be classified into those that measure blood flow and those that monitor tissue metabolism. The problem with measuring blood flow is that it can be misleading due to the phenomenon of arteriovenous shunting. Near infrared (NIR) spectroscopy is capable of identifying certain molecules in the tissues. In this study, using the reverse McFarlane rat skin flap as a model, oxygen delivery to the tissue along the flap was demonstrated in the form of a spectrum. This was achieved by using the differential absorption of oxy- and deoxyhemoglobin between wavelengths of 650 nm and 900 nm. NIR imaging works on a similar principle, but an oxygen saturation image is obtained, with the darkest area indicating the most deoxygenated area of the flap and vice versa. There were two types of studies done.

In the chronic study (n=10), NIR spectroscopy was done on the intact skin preoperatively for three days and then after elevation of the flap at various sites for three days. Preoperative measurements showed excellent reproducibility, and postoperative measurements showed progressive deoxygenation toward the distal aspect of the flap. NIR imaging at 1 h after flap elevation showed a zone of demarcation that corresponded with that noted clinically at 72 h.

In the acute study (n=3), NIR spectroscopy, imaging and laser Doppler flowmetry were acquired before, immediately following and 1 h after raising the flap, and then measurements were taken after applying a vascular clamp across the base of the flap; reperfusion was evaluated after clamp release. Spectroscopy immediately following flap elevation indicated deoxygenation of the most distant part of the flap. Clamping the base of the flap caused deoxygenation of the whole flap; this was immediately evident on both spectroscopy and imaging. These changes recovered after releasing the clamp in the areas that were expected to survive. Laser Doppler flowmetry results generally correlated well with the NIR spectroscopy and imaging results. However, the method was very sensitive to fine movements during monitoring. The main advantage of NIR monitoring is that it looks directly at oxygen consumption rather than measuring blood flow. In addition, the NIR imaging gives a global picture of the eventual fate of the flap. These properties make these devices much more practical when the flap's well-being is concerned.