bluuebunny/crossref_metadata_2025 huggingface dataset:
How Independent are Belgian Regulators?
Authors: Naert Frank , Defloor Bart
Published: February 2017

In this paper we attempt to analyse the independence of five Belgian regulatory agencies. In the theoretical part we cover the existing literature and find that independence is frequently used as a proxy for credibility. In the empirical part we use the framework constructed by Johannsen (2004) to measure the independence of Belgian regulatory agencies. In this framework four aspects of independence are identified and quantified leading to an overall independence index. Using legal analysis this framework is applied to the Belgian situation. We find that the independence of the Belgian financial regulator is very high, while the railway regulator is lacking most features of independence. The other regulators' score (the competition authority, the energy and telecommunications regulators) is somewhere in between. The overall picture is one of inconsistency.
Using Regulatory Benchmarking Techniques to Set Company Performance Targets: The Case of US Electricity
Authors: Nillesen Paul , Pollitt Michael
Published: February 2017

Consolidation in many sectors has lead to the formation of “groups of companies”. Extracting all the potential cost savings from these independent or separate operating units is a challenge given asymmetric information. We develop a step-by-step approach that applies regulatory benchmarking techniques to set efficiency targets for operating units. Holding company management – like a regulator – will want to set targets to encourage efficient operation but in the absence of full information on effort, costs and environmental conditions. Our approach using the parallel with regulation incorporates issues such as measurement error and potential environmental factors that could influence the underlying efficiency score. We demonstrate the approach using data from the US electricity distribution sector and show that substantial savings can be extracted using this approach that was originally developed for regulatory purposes.
Regulating Alongside Competition – Issues Raised in the UK Airport Market
Authors: Hemsley Chris
Published: February 2017

Airports have different characteristics to the network utilities, such as energy and water networks, and yet have historically been regulated using regulatory approaches originally designed for these natural monopoly businesses. However, airports can – and do – compete with each other and, following the recent decisions by the UK Competition Commission to require BAA to sell three of its airports, this inter-airport competition looks set to intensify.

This paper explores the issues that should be considered when the regulation sits alongside competition. This paper describes how the investment incentives created by the application of ‘RPI-X’ style price cap regulation can be similar to the incentives typically associated with ‘rate of return’ regulation; namely the existence of ‘gold plating’ incentives.

However, these distortions to incentives also affect non-regulated airports. A model is presented that illustrates the potential for perverse incentives on non-regulated airports and distortions to their investment decisions. Finally, this paper considers the case of the regulation of Stansted Airport, which illustrates that these incentive effects can occur in practice.

This paper concludes that regulators should not assume that approaches designed for natural monopolies are suitable for airports markets or in other markets where there is a degree of competition between suppliers.
Manufacturing the EU Energy Markets: The Current Dynamics of Regulatory Practice
Authors: Hancher Leigh , de Hauteclocque Adrien
Published: February 2017

The constraints of the European legal and institutional structure for decision-making in energy greatly determine the quality and the dynamics of regulatory practice, in particular the legal tools we use to build markets and how we use them. In this light, this paper aims to analyze two major developments in energy market regulation at the Union level: the creation of a new Agency for the Cooperation of Energy Regulators (ACER) and the intensified use of the EU antitrust rules by the European Commission. It first shows that ACER will not enjoy any real decision-making or veto powers and focuses on existing sources of concern. It then argues that the Commission is increasingly taking a quasi-ex ante regulatory approach through antitrust to fix the shortcomings of sector-specific regulation, even if this might be neither a suitable nor a legitimate approach. The paper concludes on the need to better articulate EU regulatory and competition-based controls to push forward the completion of the single market in energy.
A Method for Measuring Excessive Environmental Regulatory Burden in the Australian Rail Industry
Authors: von der Heidt Tania , Wang Jian , Charles Michael B.
Published: February 2017

For the Australian rail industry, environmental regulation is a regulatory hotspot causing suboptimal rail operations and business performance. Attempts to measure the cost of regulatory burden are few, more so given the conceptual and practical challenges. This article employs the prism of environmental regulation pertaining to the Australian rail industry to recap the concept of regulatory burden and evaluate possible measurement tools for costing regulatory burden. Existing models of regulatory cost measurement are adapted and applied to priority areas of dysfunctional environmental regulation across Australia. By drawing on results from a pilot study, the suitability of the methodology for quantifying an industry's regulatory burden is assessed. The article should be of interest to managers and regulators striving for more equitable and efficient regulatory approaches.
Postal Markets and Electronic Substitution: What is the Impact of Intermodal Competition on Regulatory Practices and Institutions?
Authors: Maegli Martin , Jaag Christian , Koller Martin , Trinkner Urs
Published: February 2017

The increasing convergence between postal products and telecom applications is a new phenomenon in the communications environment: postal operators provide new services on telecom infrastructures, telecom infrastructures are likely to substitute last mile mail delivery and consumers are likely to demand a secure combination of electronic and physical mail. In the course of the increased substitutability of physical mail by electronic communications and continually decreasing physical mail volumes, it becomes obvious that regulatory regimes in general and regulatory institutions in particular should co-evolve in the future. But, there is hardly any discussion in academia or in practice about the consequences for regulation. Relevant questions are: which parts of current regulation will become redundant? Is there additional regulation needed due to new bottlenecks or changes in consumer behaviour? In our qualitative analysis, we investigate the implications of intermodal competition and growing convergence between postal and telecommunications services on regulatory institutions and regimes. We provide a comparison between the networks and compare the scope of universal services and issues concerning market power regulation in the two different industries. Furthermore, we develop the idea of a unified universal definition with a holistic understanding of the topic before concluding that there is need for a unified regulatory approach in the future. Such an approach will likely consist of a jointly-defined communications universal service and consequently of corresponding regulatory strategies for policy makers.
Non-Discriminatory Energy System Operation: What Does it Mean?
Authors: Hannah Kruimer H.T.
Published: February 2017

This paper is concerned with non-discriminatory operation of energy systems and the questions of i. what discrimination in this context means, ii. what are the characteristics that distinguish system user A from system user B, and iii. whether distinctions between system users mean system users are dissimilar hence justifying differences in treatment towards them. It is argued that the non-discrimination obligation for energy system operators aims at providing the basis and the fundament upon which competition on equal terms among gas and electricity suppliers is to develop. This means that the way system operators operate their networks should facilitate competition between system users e.g. suppliers, traders, and generators/producers. Consequently, non-discriminatory system operation aims at equality of system users to the extent necessary to achieve this. This means that the non-discrimination obligation for energy system operators does not strive to reach absolute equality of system users. This paper concludes that system users differ in many ways e.g. the way they use the system, their company (risk) profile, the quality and origin of the gas/electricity they transport, and the point of time, type and amount of their system service request. These differences can both be used to demonstrate that system users should not be treated the same because they are i. not similar in the first place or ii. are not in an analogous situation. These factors cannot be used as objective justification grounds given that the EU Court only accepts justification grounds explicitly mentioned in the Directives and Regulations.
Benchmarking Economies of Vertical Integration in U.S. Electricity Supply: An Application of DEA
Authors: Meyer Roland
Published: February 2017

This study applies a frontier benchmarking approach to measure economies of scope between the vertical stages of electricity supply in the U.S. electricity industry. By comparing different frontiers for integrated and separated supply of electricity based on a bootstrapping DEA, two types of vertical unbundling are analyzed. Separating the generation stage from networks and retail appears to be the more costly alternative with an average cost increase of 19 percent. Our second scenario, covering one of the options of transmission unbundling to be implemented in the European Union, shows an average cost increase below 2 percent.
Real Unbundlings: The Foundation for a Competitive Gas Market in the United States
Authors: Makholm Jeff D.
Published: February 2017

The public policy of “unbundling” has been a prominent part of regulatory reform of the gas industry both in Europe and the United States. Two different austere unbundlings of the US gas pipeline system – one imposed rigidly by Congress in 1935, one voluntarily accepted by pipelines decades later (and later brilliantly modified by the regulator) – were prerequisites for North America's uniquely competitive gas market that fully blossomed after 2000. This paper traces the economic and institutional roots, stretching over decades, of those US pipeline unbundling efforts and contrasts those efforts to current legislated unbundling efforts in Europe.
Regulatory Unbundling in Telecommunications
Authors: Knieps Günter
Published: February 2017

Due to its dynamic nature, and the increasing importance of competitive subparts, the telecommunications sector provides particularly interesting insights for studying regulatory unbundling. Based on the theory of monopolistic bottlenecks the fallacies of overregulation by undue unbundling obligations are indicated. Neither the promotion of infrastructure competition by mandatory unbundling of competitive subparts of telecommunications infrastructure, nor regulatory induced network fragmentation within monopolistic bottleneck components is justified. The impact of the shrinking of the areas of network specific market power on the remaining unbundling regulation is analyzed. Finally, the phasing-out potentials of unbundling regulation in European telecommunications markets are pointed out.
Unbundling of Non-Profitable Rail Infrastructures
Authors: Weiss Hans-Joerg
Published: February 2017

So far the unbundling debate in the European railroad sector has concentrated on the vertical relationship between train services and rail infrastructures. This paper argues that besides this important vertical dimension there is also an important horizontal dimension of the unbundling topic in the railroad sector, namely the distinction between profitable and non-profitable rail infrastructures. The addition of the horizontal dimension is necessary to capture a special feature of the railroad sector (at least in Europe): its significant financing out of public budgets. The paper analyzes in which way unbundling of non-profitable rail infrastructures can contribute to the solution of the market power problem in the railroad sector. Two economic criteria for disaggregating the parts of a railroad system are presented: competitiveness and profitability. The two regulatory problems caused by market power are discussed. The discrimination problem exists for all rail infrastructures, irrespective of their profitability, whereas the price level problem is absent for non-profitable ones. To avoid excessive or insufficient price regulation, the implementation of horizontal accounting separation is recommended. Finally, it is argued that accounting separation to tackle the market power problem will also contribute to the solution of the procurement problem in case of subsidized rail infrastructures.
How to Regulate a Market-Driven Rollout of Smart Meters? A Multi-Sided Market Perspective
Authors: Schächtele Jan , Uhlenbrock Jens
Published: February 2017

Smart (electricity) meters are regarded as a crucial element to increase energy efficiency by better balancing energy supply and demand. Nevertheless, most countries so far have not seen a comprehensive smart meter rollout; neither mandated by a regulatory directive nor through autonomous market forces. A key economic obstacle to a market-driven rollout is the fragmentation of benefits among multiple stakeholders, which disperses investment incentives. In this article we investigate how to best overcome this investment barrier by analyzing three distinct smart meter market structures. A key parameter for the analysis is the recognition that the smart meter market is multi-sided, making it essential to consider its peculiar characteristics. Our qualitative analysis indicates that a combined smart meter and distribution grid operator, with a regulatory setup that permits the socialization of smart meter investment costs among all electricity consumers, is best suited to implement a market-driven smart meter rollout.
The Long-Term Regulation of Safety Standards: The Case of the Electricity Industry in Australia and New Zealand
Authors: Abbott Malcolm
Published: February 2017

Throughout much of the history of the electricity industry in Australia and New Zealand the industry has been the subject of safety regulations. Although this regulation has been a constant throughout the life of the industry the organizational approach to regulation has changed over the years. Periodically in Australia and New Zealand history these questions have been raised in a political context, although notably the structure of safety regulators does not get much attention in the standard histories of the industry. The purpose of this paper, therefore, is to discuss some of the general issues that have arisen in the reform of regulation in the case of electricity safety over the longer term and how it relates overall to the development of the electricity industry.
Towards Best Practice in Measuring Regulatory Burdens: A Case Study of Environmental Regulation in the Australian Rail Industry
Authors: Wang Jian , von der Heidt Tania , Charles Michael B.
Published: February 2017

This article presents a methodology for quantifying the costs of dysfunctional environmental regulation faced by the Australian rail industry and derives indicative lessons for best practice with respect to measuring regulatory burden. By drawing on results from a recent benchmarking analysis, the suitability of the methodology is assessed. The study suggests that the methodology presented could be applied to other industries seeking to measure the policy-inefficient government regulatory burden. Further methodological improvements are also recommended.
Capacity Choice in Decentralized Grid-Bound Industries
Authors: Janssen Matthias , Lingens Jörg , Wobben Magnus
Published: February 2017

In grid-bound industries, individual investment in production capacity constitutes a public good in the form of a delivery insurance for all market participants. We analyze the effects of entry (caused e.g. by deregulation) on capacity and output choice in these industries. To this end we employ a Cournot-model with symmetric firms and firm-specific capacity shocks. Our results reveal that the standard welfare-enhancing competition effect of an increasing number of firms, induced by lower prices and higher output quantities, is countervailed by a decrease in delivery insurance and thus by a growing probability of delivery disruptions (blackouts). Beyond a certain number of firms, the latter effect dominates. As a consequence, the socially optimal number of firms is bounded. We calibrate the model on data of the German electric power market to get a notion of this optimal number firms.
The Reliability of Energy Infrastructures; The Organizational Requirements of Technical Operations
Authors: Scholten Daniel
Published: February 2017

The reliable operation of energy infrastructures is more than just a technical matter. It is also dependent upon the organizational structure that enables and constrains entities in their management of operations. Yet while this lesson is well-known to scholars, there still exists a lack of understanding on how multiple actors should coordinate their actions to reliably operate energy infrastructures. In response, this paper proposes a framework that allows establishing the organizational structures required for the reliable operation of energy systems. The result is a stepwise progression that moves from the technical characteristics of energy infrastructures to the organizational structure required to facilitate reliable operations via identifying the critical technical functions and their accompanying control mechanisms and then establishing the responsibilities and coordination requirements that they imply for the entities involved in operations. The paper ends with a reflection on in how far we have achieved the intention and what still needs to be done.
The Coordinated Development of Offshore Energy Infrastructure: Legal Challenges and Possible Solutions
Authors: Müller Hannah Katharina
Published: February 2017

There will be an enormous growth of offshore wind energy generation in the North Sea if current plans are given effect. Standard practice for wind farms constructed to date has been to provide each wind farm with a dedicated cable connection to the onshore transmission system (radial connection). A more efficient approach would be to initiate coordinated projects that involve the clustering of wind farms and consequently allow for shared offshore assets. This could lower the costs and reduce the impacts on the marine environment. However, national regimes currently focus on the installation of radial connections and do not promote the coordinated development of offshore infrastructure. The purpose of this article is to identify the legal barriers to these coordinated projects and to explore what changes could be made to the current regulatory practices of the North Sea states in order to introduce the required coordination between wind energy generation and infrastructure development.
Market Power of Airports: A Case Study for Amsterdam Airport Schiphol
Authors: Bilotkach Volodymyr , Polk Andreas
Published: February 2017

We analyze the extent of market power of Amsterdam airport Schiphol in its aviation related business. First, we use information on airport charges, and a natural experiment with a passenger tax, to propose a detailed delineation of markets for the airport. Our market definition is in line with the European competition case practice, and we consider the applied methodology as also relevant for other airports. As the second step, we assess the market power of Amsterdam airport Schiphol in all the markets we have defined. We empirically analyze overlaps in the markets served by the airport and catchment areas of the airport, and demonstrate how this approach is helpful in determining the extent of the market power of an airport.
Integrated Timetables for Railway Passenger Transport Services
Authors: Finger Matthias , Haller Andreas , Martins Sonia Strube , Trinkner Urs
Published: February 2017

Rail passenger transport services with integrated regular interval timetables (IRIT) offer passengers a regular interval timetable for services on the railway network. IRIT have the potential to increase the quality and attractiveness of railway passenger services in comparison to other transport modes. This article summarizes the advantages and challenges of an implementation of IRIT for railway passenger services and derives the main requirements for the successful introduction of IRIT.

The comparison of the regulatory framework, the role of IRIT and the development of passenger railway services in CH, the NL and the UK, shows that in those countries, where either IRIT has been introduced (CH) or the high frequency of trains between cities provides for a system comparable to IRIT (NL), railway services play a more important role in the modal split. The successful introduction of IRIT requires a long-run implementation schedule which identifies the necessary investments in the railway infrastructure and points out the financial resources available to make those investments. Furthermore, IRIT requires a high level of punctuality of railway passenger services, the coordination between railway companies when designing the timetable and a priority rule for passenger railway services within IRIT when there are capacity restrictions on the railway network.
Governance in Network Industries: Lessons Learnt from New Institutional Economics
Authors: Glachant Jean-Michel
Published: February 2017

This article reflects on personal observations during twenty years of professional career about the ideas developed within New Institutional Economics (NIE). The general theory is analysed by studying the views of Coase, North, Williamson and Ostrom and subsequently the characteristics and specific requirements of network industries are confronted with each of the authors. Is it relevant to study network industries using the tools and ideas developed by NIE scholars? If so, what views are more relevant in the current multi-channel and multi-level reality? Do “institutions matter” for the case, and if so, in what way?
The Results of Modernizing Network Industries
Authors: Bolognesi Thomas
Published: February 2017

Since the 1980s, the European Union favours regulatory reforms in network industries and the water sector appears to be the latest to be included in this. We deal with this issue while questioning the concept of “modernization of the Urban Water Systems in Europe” (UWSE). This process began in the second half of 1990 and the Water framework directive (2000) constitutes its main element. Three core principles provide the basis for the modernization of UWSEs: 1/ a rationalisation of the public command; 2/ an increasing use of market mechanisms; 3/ the identification of sustainable development goals. After implementation it appears that many UWSEs fall short of expectations.

Our analysis is concentrated on the impacts and the operating mechanisms, impacts of such reform. It is argued that modernization entails a change in the modalities of coordinating UWSEs, while intensifying and polarizing the problems of sustainability around economic issues. At an organizational level, modernization tends to depoliticize UWSEs and increase socio-institutional resilience. These two phenomena are mainly the result of hybridization of institutional arrangements in favor of the market. With respect to sustainability potential, the lack of coherence in the development of UWSEs re-regulation explains the relatively gloomy outlook.
National Broadband Networks of Malaysia, India, Indonesia and Australia
Authors: Gunaratne Roshanthi Lucas , Ilavarasan P Vigneswara , Fernando Sabina , Rohman Ibrahim Kholilul
Published: February 2017

This paper presents a comparison of national broadband networks (NBNs) of four different countries – Malaysia, India, Indonesia and Australia – by describing their rationale, scope, funding, technology and current status. The networks are analyzed for their cost effectiveness, demand stimulation, conduciveness for competition and technology. The networks are fiber based and are implemented by the incumbent as in Malaysia or a special purpose vehicle which is led by the incumbent as in India. Across the four countries, there are differences in terms of funding, implementation entity, point of access by the network, period of implementation and the objectives. The paper is expected to help policy makers in the developing world in devising plans that ensure open access to the networks and promote fair competition.
The Costs of Inappropriate Delegation
Authors: Tangirala Maruthi P.
Published: February 2017

Independent regulators are imagined as non-majoritarian institutions that are expected to function at arm's-length from other branches of government so that decisions are made on the basis of expertise. The extent of their powers and the nature of their delegation crucially affect the performance of regulatory bodies since over- or under-delegation tends to increase social costs. This paper attempts to examine the evolution of regulatory governance in the Indian telecom sector by examining the statute governing TRAI and whether it has been successful in establishing a robust regulatory framework.
The Alignment Framework
Authors: Finger Matthias , Crettenand Nicolas , Lemstra Wolter
Published: February 2017

This article provides an overview of the alignment framework, also called the coherence framework. Its aim is twofold, as it first documents the recent improvements of the framework and secondly outlines the conceptual foundations for the case studies of this special issue. The framework is in fact a tool for the evaluation of the performance of the network industries. As such, it is based upon an assessment of the degree of alignment between the related technologies and institutions. More precisely, the article starts out by reviewing the constituting parts of the framework, followed by a discussion of three improvements to the framework, namely the refinement of the alignment definition, the development of the role of the actors, as well as further contributions to the role of convergence and innovation. Finally, the link between alignment and performance is discussed in more detail.
Socio-Technical Lock-in and the Alignment Framework: The Case of Distributed Generation Technologies
Authors: Bauwens Thomas
Published: February 2017

Whereas a centralized energy supply system is still dominant today, the energy sector is currently witnessing the development of small-scale and more geographically dispersed generation units, so-called distributed generation technologies. The alignment framework proposes a very useful approach to look at this evolution. Yet, we argue in this paper that this framework does not fully take into account the inertia associated with past technological and institutional choices that may hinder future changes. Relying on the concept of socio-technical lock-in, we illustrate this point with the case of the diffusion of distributed generation technologies. Based on this analysis, we propose an adaptation of the alignment framework in order to integrate these elements.
Competition in the German Interurban Bus Industry
Authors: Dürr Niklas S. , Hüschelrath Kai
Published: February 2017

We study competition in the German interurban bus industry two years after its liberalization in January 2013. In addition to a brief characterization of the liberalization process and several general market developments, we provide a detailed analysis of selected market characteristics such as concentration and competitive interaction, fares as well as service quality. We use the gained insights to discuss two recent policy issues – industry consolidation and possible abuses of market power by incumbents – and derive several recommendations to secure effective competition in the industry.
The Collective Bargaining Authorization Provision for SMEs in the Australian Competition Law
Authors: Rahim Mia Mahmudur , Brady Iolani
Published: February 2017

This article examines the collective bargaining provisions for SMEs in competition law in Australia. It concludes that SMEs' use of the collective bargaining notification process has been relatively small and does not have any impact over the competition regulation in the market. While this provision helps SMEs supply reasonably homogenous products or services, it is otherwise limited in its application.
European Energy Regulators
Authors: Jong Thijs , Woerdman Edwin
Published: February 2017

This paper examines empirically whether the differences in legal competences of National Regulatory Authorities (NRAs) of European gas and electricity markets are aligned to the corresponding countries' divergent levels of 1) security, 2) competitiveness, and 3) carbon-neutrality of energy supply. Scores are derived (a) on the extent to which these energy supply characteristics are realized and (b) on how many competences NRAs have regarding these policy objectives. Although higher energy scores should reduce the need for regulatory intervention and thus legal competences, it appears that this does not hold for most of the policy objectives. In fact, gas and electricity market unbundling and liberalization imply higher degrees of regulatory intervention. Finally, the legal competences do not completely follow the ‘optimal’ competence arrangement for regulatory authorities; compared with a theoretical benchmark there are relatively more ‘tough’ than ‘soft’ competences, while the latter are less costly to exercise. These potential regulatory ‘mismatches’ could be corrected by adjusting the number and intrusiveness of the NRAs' legal powers.
The Impact of Network Competition in the Mobile Industry
Authors: Houpis George , Rodriguez Jose Maria , Serdarević Goran , Ovington Tom
Published: February 2017

In 2000, there were as many countries served by a single mobile network as by network competition. Today only 30 countries, representing less than 3% of the world's population, are served by a single network. There has been considerable discussion about the optimal number of network operators in the mobile industry. More recently, some regulators and governments have considered implementing a single wholesale network to deliver next generation mobile services due to concerns around low coverage, inefficient duplication of costs and lack of competition. To date, we are not aware of any single wholesale networks fully implemented in the mobile industry. What is clear is that single wholesale networks represent a turnaround with respect to the way in which the mobile industry has developed worldwide. Therefore, it is important to carefully examine the available evidence on the performance of mobile markets in countries with a single mobile network, as this could shed some light on the expected performance of single wholesale networks. The key result is that countries with network competition have higher coverage, higher take-up and greater innovation than countries with a single mobile network, controlling for other relevant factors. This paper represents a significant contribution to the literature, as we are not aware of any other papers that have considered the impact of network competition compared to single networks on outcomes such as coverage. The results of the paper have significant policy implications, as they imply that moving away from the network competition model into the world of single wholesale networks could cause considerable consumer harm, which may be difficult to reverse once there has been a move away from network competition.
Integrating Stakeholders into the Governance of Data Exchange from Smart Metering
Authors: Buchmann Marius
Published: February 2017

The electricity supply chain is changing due to the integration of renewable energies. Two developments are in the focus of this paper: First, the emergence of third parties and second, the requirement for information management (i.e. the management of data exchange from smart metering) as a new step in the supply chain. Information management needs to secure the neutral and non-discriminatory integration of third parties into smart grids. This can be accomplished by a collaborative governance approach. Based on veto player theory we identify two key issues for the voting process within a collaborative governance approach for information management. First, we show that a voting process based on “individual veto players” will result in governance lock-in situations, where governance innovation will be impeded. Second, we discuss that “collective veto players” can secure governance innovation for information management, but that the non-discriminatory integration for third parties might be at stake, if less than a qualified majority is required to vote on a veto.
Open with Care: The Duopoly Model for the Transition to Competition in Long-Distance Passenger Railway Transportation
Authors: Montero Juan J. , Ramos Rodolfo , Giuricin Andrea
Published: February 2017

Railways present specific obstacles for the introduction of competition. The duopoly model for the transition to competition makes it possible to overcome some of these obstacles. The granting of a second license allows governments to control the process and exclude opportunistic market entry limited to high-volume routes with high margins. Temporary exclusion of contestability allows the newcomer to achieve the necessary economies of density and scale. Finally, more limited competition allows the incumbent adapting to the new market structure by reducing costs and putting an end to internal cross-subsidies.
The modern role of androgen deprivation therapy in the management of localised and locally advanced prostate cancer
Authors: Gunner Charlotte , Gulamhusein Aziz , Rosario Derek J
Published: February 2017

Introduction:

Approximately 50% of men diagnosed with prostate cancer will be exposed to androgen deprivation therapy (ADT) at some stage. The role of ADT in the management of metastatic disease has long been recognised, and its place in the management of localised and locally advanced disease has become clearer in the past few years. Nevertheless, concerns remain that some men might not benefit from ADT in earlier-stage disease. The purpose of the current article is to provide a brief narrative review of the role of ADT as part of a strategy of treatment with curative intent, concentrating mainly on key recent developments in the area.

Methods:

Narrative literature review of key publications in the English language relating to ADT in the management of localised and locally advanced prostate cancer.

Results:

In locally advanced and high-risk localised prostate cancer, the use of ADT in combination with radiotherapy improves disease-specific and overall survival. There is no evidence to support the use of ADT in the treatment of low-risk localised prostate cancer. There appears to be an increased risk of cardiovascular morbidity and mortality associated with luteinizing hormone-releasing hormone agonists, particularly in men with pre-existing cardiovascular disease, but the relevance of this in the adjuvant/neoadjuvant setting is currently unclear.

Conclusions:

Future studies should focus on identification of men who are at risk from cardiovascular complications associated with ADT and on the comparison of radiotherapy with ADT versus surgery in the management of localised and locally advanced prostate cancer, particularly with regards to men with pre-existing comorbidities.
Novel concepts for risk stratification in prostate cancer
Authors: Patel Keval M , Gnanapragasam Vincent J
Published: February 2017

Since Partin introduced the analysis of prostate-specific antigen, clinical T-stage and Gleason scores to estimate the risk of progression in men with localised prostate cancer, our understanding of factors that modify this risk has changed drastically. There are now multiple risk stratification tools available, including look-up tables, risk stratification/classification analyses, regression-tree analyses, nomograms and artificial neural networks. Concurrently, descriptions of novel biopsy strategies, imaging modalities and biomarkers are frequently published with the aim of improving risk stratification. With an abundance of new information available, incorporating advances into clinical practice can be confusing. This article aims to outline the major novel concepts in prostate cancer risk stratification for men with biopsy confirmed prostate cancer. We will detail which of these novel techniques and tools are likely to be adopted to aid treatment decisions and enable more accurate post-diagnosis, pretreatment risk stratification.
The role of chemotherapy and new targeted agents in the management of primary prostate cancer
Authors: Kumar Sanjeev Srinivas , Pacey Simon
Published: February 2017

While early treatment of primary prostate cancer is very effective, the incidence of primary prostate cancer continues to rise and therefore the detection of men with high-risk non-metastatic prostate cancer and their subsequent management is becoming increasingly important. There continues to be no molecularly-targeted or chemotherapeutic options with proven, statistically significant survival benefit in this setting. However, there are indications that further risk stratification using molecular features could potentially help distinguish indolent from aggressive prostate cancer, ultimately providing biological markers that could guide a more personalised approach to therapy selection.
Age, Sex, Body Mass Index, Education, and Social Support Influence Functional Results After Total Knee Arthroplasty
Authors: Sveikata Tomas , Porvaneckas Narunas , Kanopa Paulius , Molyte Alma , Klimas Dalius , Uvarovas Valentinas , Venalis Algirdas
Published: February 2017

Introduction:

Total knee arthroplasty (TKA) is an effective treatment for knee osteoarthritis. Patient-reported outcome after TKA is influenced by multiple patient-related factors. The aim of this study was to prospectively evaluate preoperative patient-related factors and to compare the self-reported outcomes 1 year after TKA among groups differing by age, sex, body mass index (BMI), education, and social support level.

Methods:

314 patients, who underwent TKA in Vilnius Republican University Hospital between the end of 2012 and the middle of 2014, were included in a study. The preoperative and 12-month follow-up measurements were obtained using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form-12 (SF-12). Differences between patient groups according to gender, age, BMI, level of education, and level of social support were analyzed.

Results:

At 12-month follow-up men demonstrated better results than women in WOMAC ( P = .003) and SF-12 both domains ( P < .05). Patients with a higher social support demonstrated higher scores in physical function according to SF-12 ( P = .008). Better preoperative WOMAC and SF-12 scores were a predictor of better outcome 1 year after surgery. There was no difference in postoperative scores in different age, BMI, and education groups according to WOMAC and SF-12.

Conclusion:

There is no difference in self-reported functional outcome between patient groups differing in age, BMI, and education. Men and socially supported patients demonstrate better postoperative functional results 12 months after TKA. Better preoperative knee function and overall physical and mental function are predictors of better outcome 1 year after TKA. Age and obesity should not be limiting factors when considering who should receive this surgery.
Perceived Parenting Practices and Adjustment
Authors: Jorgensen Nathan A. , Nelson Larry J. , Duan Xinxing
Published: February 2017

Filial piety is an important cultural construct in the lives and behaviors of Chinese emerging adults and may act as a moderating factor for the relationship between perceived parenting practices and indices of adjustment. The purpose of this study was to investigate whether or not filial piety moderates the influence of psychologically controlling and warm parenting behaviors on internalizing problems, self-esteem, and risk behaviors. Using a sample of Chinese college students ( N = 612), results from regression analyses indicated that filial piety moderated the relationship between psychological control and self-esteem, in that psychological control predicted lower self-esteem at high and moderate levels of filial piety values but was not related at low filial piety values. The discussion focuses on the possibility that filial piety may exacerbate the conflict between psychologically controlling tactics and autonomy.
Comparison of Techniques Used to Locate the Malar Eminence
Authors: Nechala Patrik , Mahoney James , Farkas Leslie G
Published: February 2017

Introduction

The malar eminence is of surgical interest for several reasons including facial trauma, esthetics and congenital anomalies.

Objective

To compare several techniques developed to locate the malar eminence on live subjects.

Methods

An initial trial involving 30 men and women located the malar eminence using Hinderer's, Wilkinson's, Powell's and maxillozygion methods. A subsequent trial used a custom-made measuring device called the anthropometer to examine 11 volunteers. In this part of the study, only Hinderer's and Wilkinson's methods of intersecting lines were used in addition to the palpated maxillozygion. The location of the three points was recorded relative to the vertex, opisthocranion and facial midline.

Results

During the initial trial, it was recognized that Powell's method of intersecting lines describes a point too lateral to use concomitantly with the other methods of intersecting lines. The distances of Hinderer's, Wilkinson's and Powell's points from the maxillozygion were 8.5±2.9 mm, 7.6±3.3 mm and 28.4±4.8 mm, respectively. In the second part of the study, Hinderer's point, in general, is medial and inferior to the maxillozygion, while Wilkinson's point is lateral and an equal distance from the vertex as the maxillozygion. The three points appear to be randomly interspersed in their distances from the opisthocranion.

Conclusions

By combining the techniques of intersecting lines and direct palpation, a more comprehensive evaluation of the malar complex can be made. This is especially true in cases where there exists an asymmetry in the bony skeleton that is then compensated by the overlying soft tissues.
Dynamic Compression Bone Clamp for Transverse Fractures
Authors: Lalonde Donald H
Published: February 2017

A bone clamp with the following important features is described: it provides a dynamic compression force to transversely fractured bone ends before they are fixed with internal hardware; it is designed to reduce transverse bone fractures; and it holds the bone with sharp, opposing points like a towel clip.
Current Status of Suction Lipectomy in Canada: A Cross-Sectional Survey of Plastic Surgeons
Authors: Schwarz Gaston , Pusic Andrea L
Published: February 2017

Background

Suction lipectomy is the most common aesthetic surgery performed in North America. The safety of the procedure has recently been questioned, particularly with respect to large volume aspiration.

Objective

To delineate Canadian liposuction practice patterns and perceived complication rates.

Subjects and Methods

A survey was mailed to all plastic surgeons registered with the Canadian Society of Plastic Surgeons. The survey assessed surgeon demographics, hospital admission rates following liposuction, techniques used, wetting solutions, aspirate volumes and complications.

Results

A total of 322 surveys were mailed. The response rate was 44%. Of the 142 surgeons who responded, 119 regularly performed suction lipectomy. They reported that 70% of patients had suction lipectomy performed on an outpatient basis. Forty per cent of procedures were performed in private clinics. On average, surgeons performed 40 liposuctions/year without ancillary procedures and 27 liposuctions/year with ancillary procedures. Fifteen per cent of surgeons used ultrasound-assisted liposuction as an adjunct to traditional liposuction, although less than 1% used it exclusively. The ratio of aspirate to infiltrate was 0.25 to one in 45% of cases, 0.5 to one in 37%, one to one in 17% and one to one in fewer than 1%. In 69% of patients, 1 to 2 L was aspirated, while in fewer than 5% of patients, more than 3.5 L was aspirated. Early complication rates were as follows: hematoma and seroma 2.6%, infection 1.3% and skin loss 0.01%. Contour irregularity was the main late complication, occurring in 12% of patients. No cases of venous thrombosis, or pulmonary or fat emboli were reported. No deaths were reported.

Conclusions

Suction lipectomy is performed commonly by Canadian plastic surgeons, with the majority using a wet or superwet technique. In the vast majority of patients, fewer than 3500 cm3 are aspirated. The complication rate is perceived to be low.
Nerve Growth Potential of FK 506 and Its Analogues – A Systematic review of Controlled Trials in Rats
Authors: Nelluri Pramod K , Lyons Robert , Severo Antonio , Peterson Darryl W , Chettipally Uli K , Garza Jamie R
Published: February 2017

Background

Nerve injuries of the upper extremity seldom regain full preinjury function. Delay in nerve repair, nerve gap and ischemic local conditions are some of the factors attributed as the cause. The proximal axonal segment regenerates in the presence of neuronotrophic factors present in nerve tissue. FK 506 and its nonimmunosuppressive analogues have been shown to influence the growth of axons experimentally. Parallel studies of animals and human beings have demonstrated strong, toxic effects of these agents.

Purpose

To review systematically data on the role of FK 506 and its analogues in peripheral nerve regeneration of randomized, controlled trials in rats. Reports dealing with the toxic effects of these agents all were reviewed as well.

Methods

Articles and reviews were identified through a computerized search of MEDLINE from January 1966 to September 1999 by using the terms “FK 506”, “FKBP-12 ligands”, “peripheral nerve regeneration” and “nephrotoxicity, cardiotoxicity and neurotoxicity in FK 506”. Two reviewers assessed the trials independently.

Results

FK 506 caused dose-related enhancement of axonal growth in all animals that were tested and for all routes of drug administration. Effects of FK 506 when used locally and of its analogues occurred in the same order as those of the parent drug.

Conclusions

FK 506 and its analogues have been experimentally proven to be potent nerve stimulators. Further studies are warranted in view of the pathological and clinical potential for nephrotoxicity and cardiotoxicity of these agents. The authors proposed an experimental model incorporating a nerve conduit filled with slow release FK 506 at the site of nerve gap or crush, thus decreasing its systemic effects.