The fact that Amazon was allowed to acquire hundreds of companies as it rose to become the fourth most valuable U.S. company in terms of market capitalization and a leader in three lines of business ...has been viewed by some as damning evidence of underenforcement by the United States antitrust authorities. In this article we ask the obvious question: If the 2023 Guidelines had been in place instead of prior guidelines, what effects would they have had on Amazon’s development? To provide an answer, we identify relevant changes in the guidelines and then select for review a subset of Amazon’s 280 acquisitions over the period 1998 to 2022. In our counterfactual, we analyze five horizontal acquisitions, four vertical acquisitions, and two sets of
serial acquisitions
. We find that the 2023 Guidelines would have broadened the bases for potential challenges and thereby would have increased the likelihood that Amazon would have faced greater resistance from antitrust authorities. The lack of safe harbors, the plasticity of individual Guidelines, and the optionality to challenge mergers under alternative theories would have exposed most of Amazon’s acquisitions to challenge. The lack of meaningful guidance about which individual transactions would have been challenged suggests that going forward enforcer discretion will play a yet larger role. Regarding Amazon’s serial acquisitions of nearly one hundred technology firms, we find that the 2023 Guidelines would have provided multiple rationales for intervention. Therein lies a weakness in the Guidelines and in antitrust policy: the lack of a framework for assessing both the anticompetitive and procompetitive effects of such acquisitions in high-tech industries.
For more than 50 years there has been an ongoing effort to combat transfusion‐transmitted infections and provide patients with the safest possible blood. This initiative has driven much of the ...research within the transfusion community. Initial methods included screening donors for travel histories to banned areas and for high‐risk behaviors, but pathogen‐specific assays performed at the collection and manufacturing sites also have become key factors in assuring blood safety. Many of these have focused on donor and laboratory‐based screening for transfusion‐transmitted diseases, as evidenced by the hepatitis and human immunodeficiency virus screening in the 1970s, 1980s, and 1990s. More recently, this effort has expanded to develop donor screening assays to identify other blood‐borne pathogens, such as Zika and West Nile viruses and Babesia. Bacterial contamination of units of platelets (PLTs), however, remains a significant concern. In recent years, the Food and Drug Administration has approved rapid tests to identify bacterially contaminated PLT units in the blood bank before transfusion. Other supplemental methods have been developed, however, that aim to inactivate blood‐borne pathogen(s) present in the blood product, rather than to rely on our ability to identify and interdict contaminated and infected components. Pathogen reduction technology, as this is referred to, provides a proactive way to further reduce the risk posed by transfusion‐transmitted infections.
BACKGROUND
Prevalence estimates of the serious hazards of transfusion vary widely. We hypothesized that the current reporting infrastructure in the United States fails to capture many transfusion ...reactions and undertook a multicenter study using active surveillance, data review, and adjudication to test this hypothesis.
STUDY DESIGN AND METHODS
A retrospective record review was completed for a random sample of 17% of all inpatient transfusion episodes over 6 months at four academic tertiary care hospitals, with an episode defined as all blood products released to a patient in 6 hours. Data were recorded by trained clinical research nurses, and serious reactions were adjudicated by a panel of transfusion medicine experts.
RESULTS
Of 4857 transfusion episodes investigated, 1.1% were associated with a serious reaction. Transfusion‐associated circulatory overload was the most frequent serious reaction noted, being identified in 1% of transfusion episodes. Despite clinical notes describing a potential transfusion association in 59% of these cases, only 5.1% were reported to the transfusion service. Suspected transfusion‐related acute lung injury/possible transfusion‐related acute lung injury, anaphylactic, and hypotensive reactions were noted in 0.08, 0.02, and 0.02% of transfusion episodes, respectively. Minor reactions, including febrile nonhemolytic and allergic, were noted in 0.62 and 0.29% of transfusion episodes, respectively, with 30 and 50% reported to the transfusion service.
CONCLUSION
Underreporting of cardiopulmonary transfusion reactions is striking among academic, tertiary care hospitals. Complete and accurate reporting is essential to identify, define, establish pathogenesis, and mitigate/treat transfusion reactions. A better understanding of the failure to report may improve the accuracy of passive reporting systems.
Principles of ethical practice Snyder, Edward “Chopper”
American journal of orthodontics and dentofacial orthopedics,
20/May , Volume:
153, Issue:
5
Journal Article
The thesis of this article is that the gap left by the abandoned Vertical Merger Guidelines (VMGs) is small, and that the gap should not be filled until a sound foundation for guidelines is built. ...The VMGs operated with a narrow scaffolding in a vast space of real-world decisions and a continuum of organizational forms. The illustrations in the VMGs were based on pricing models that show that anticompetitive exclusion may result from vertical mergers. But these models are incapable of generalization, and they do not account for investments, market uncertainty, contracting problems, information asymmetries, and governance issues. Perplexingly, the VMGs ignored research that considers such factors and illuminates a broad range of empirically verifiable efficiencies. The requisite foundation for effective vertical guidelines is not in place. Until it is developed, replacements will fail to screen vertical mergers that do not raise concerns and will not be of assistance when mergers are challenged. Antitrust scholars could advance the foundational work by developing authoritative briefs on topics such as anticompetitive exclusion, asset-specific investments, incomplete contracts and opportunistic behavior, information asymmetries and principal–agent problems, the purposes and effects of restrictive contracts, and the implications of network economies for the scope of firms.
Pathogens threaten the safety of the blood supply, but we have typically relied on a reactive approach to these threats. Having approved three new pathogen-reduction technologies, the FDA could and ...should mandate treatment of blood components by such technologies.
Existing and emerging pathogens including viruses, bacteria, protozoa, and prions continue to threaten the safety of the blood supply. Blood-collecting facilities, including community and hospital blood banks, have typically relied on a reactive approach to these threats, developing and implementing screening tests after potential pathogens are identified. During this often slow and laborious process, pathogen transmission through transfusion is inevitable. The Food and Drug Administration (FDA) recently approved three new pathogen-reduction technologies (see table). These systems are capable of inactivating a wide variety of pathogens in donated blood components, potentially eliminating threats — including some for which no other intervention . . .
Summary
Pathogen‐reduced (PR) platelets are routinely used in many countries. Some studies reported changes in platelet and red blood cell (RBC) transfusion requirements in patients who received PR ...platelets when compared to conventional (CONV) platelets. Over a 28‐month period we retrospectively analysed platelet utilisation, RBC transfusion trends, and transfusion reaction rates data from all transfused adult patients transfused at the Yale‐New Haven Hospital, New Haven, CT, USA. We determined the number of RBC and platelet components administered between 2 and 24, 48, 72 or 96 h. A total of 3767 patients received 21 907 platelet components (CONV = 8912; PR = 12 995); 1,087 patients received only CONV platelets (1578 components) and 1,466 patients received only PR platelets (2604 components). The number of subsequently transfused platelet components was slightly higher following PR platelet components (P < 0·05); however, fewer RBCs were transfused following PR platelet administration (P < 0·05). The mean time‐to‐next platelet component transfusion was slightly shorter following PR platelet transfusion (P = 0·002). The rate of non‐septic transfusion reactions did not differ (all P > 0·05). Septic transfusion reactions (N = 5) were seen only after CONV platelet transfusions (P = 0·011). These results provide evidence for comparable clinical efficacy of PR and CONV platelets. PR platelets eliminated septic transfusion reactions without increased risk of other types of transfusions with only slight increase in platelet utilisation.
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