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Scholars have long recognized that the states’ authority to charter corporations bolstered their antitrust powers in ways that were not available to the federal government. Our paper contributes to this literature by focusing attention on the relevance for competition policy of lawsuits brought by minority shareholders against their own companies, especially lawsuits challenging voting trusts. Historically judges had been reluctant to intervene in corporations’ internal affairs and had been wary of the potential for opportunism in shareholders’ derivative suits. By the end of the nineteenth century, however, they had begun to revise their views and see shareholders as useful allies in the struggle against monopoly. Although the balance between judges’ suspicion of and support for shareholders’ activism shifted back and forth over time, in the end the lawsuits provoked state legislatures to strengthen antitrust policy by making devices like voting trusts unsuitable for purposes of economic concentration.

A long-standing, and deeply controversial, question in constitutional law is whether or not the Constitution's protections for “persons” and “people” extend to corporations. Law professor Adam Winkler's We the Corporations chronicles the most important legal battles launched by corporations to “win their constitutional rights,” by which he means both civil rights against discriminatory state action and civil liberties enshrined in the Bill of Rights and the Constitution (p. xvii). Today, we think of the former as the right to be free from unequal treatment, often protected by statutory laws, and the latter as liberties that affect the ability to live one's life fully, such as the freedom of religion, speech, or association. The vim in Winkler's argument is that the court blurred this distinction when it applied liberty rights to nonprofit corporations and then, through a series of twentieth-century rulings, corporations were able to advance greater claims to liberty rights. Ultimately, those liberty rights have been employed to strike down significant bipartisan regulations, such as campaign finance laws, which were intended to advance democratic participation in the political process. At its core, this book asks, to what extent do “we the people” rule corporations and to what extent do they rule us?

Background: Insertable cardiac monitors (ICMs) are recommended early in the evaluation of unexplained syncope patients after a non-diagnostic initial evaluation, and have been demonstrated as cost-effective for arrhythmia detection in this population. However, pathways frequently include short-term external cardiac monitors (ECM) prior to ICM. Objective: We aimed to evaluate the cost-effectiveness of immediate ICM versus a delayed ICM approach (30-day ECM followed by ICM in patients remaining undiagnosed), in unexplained syncope patients in the U.S. Methods: A discrete state Markov model assessed the cost-effectiveness of immediate vs. delayed ICM, from a U.S. payer perspective. Cohort characteristics were informed using the 2008-2016 Optum ® Clinformatics ® U.S. claims database. Syncope recurrence was modeled based on the EasyAs trial, with risks of mortality, injury, and quality of life consequences identified from the literature. ICM data capture was based on data for Reveal LINQ™ ICM. Diagnostic success with ECM was simulated based on the likelihood of monitoring occurring simultaneously to syncopal recurrence and patient adherence. Cost inputs were derived from claims and national average payment data. All diagnostic and arrhythmia-related treatment costs and benefits were modeled over a lifetime horizon, and future costs/effects were discounted at 3% per annum. Results: Immediate ICM was associated with lower lifetime per-patient costs compared to delayed ICM ($36,348 vs.$36,826), and a gain of 0.013 quality-adjusted life-years. This was largely driven by the cost of ECMs in the delayed ICM strategy, totaling $616,600 per 1,000 patients but with a small diagnostic yield such that 92.8%of patients required an ICM. The immediate ICM approach remained the dominant strategy when the assumed patient adherence to prescribed ECM was increased to 100%, and regardless of the choice of initial ECM (1, 2, 14, or 30-day monitor). Cost savings with immediate ICM increased further in scenarios assuming some delayed ICM patients are loss to follow-up after the initial ECM. Conclusions: A strategy of immediate ICM was cost-saving compared to delayed ICM, due to the cost and low diagnostic yield of ECM and the delay in arrhythmia detection and treatment.

The key pieces of antitrust legislation in the United States—the Sherman Antitrust Act of 1890 and the Clayton Act of 1914—contain broad language that has afforded the courts wide latitude in interpreting and enforcing the law. This article chronicles the judiciary’s shifting interpretations of antitrust law and policy over the past 125 years. It argues that jurists, law enforcement agencies, and private litigants have revised their approaches to antitrust to accommodate economic shocks, technological developments, and predominant economic wisdom. Over time an economic logic that prioritizes lowest consumer prices as a signal of allocative efficiency—known as the consumer welfare standard—has replaced the older political objectives of antitrust, such as protecting independent proprietors or small businesses, or reducing wealth transfers from consumers to producers. However, a new group of progressive activists has again called for revamping antitrust so as to revive enforcement against dominant firms, especially in digital markets, and to refocus attention on the political effects of antitrust law and policy. This shift suggests that antitrust may remain a contested field for scholarly and popular debate.

In the decades before World War II, U.S. antitrust law was anything but settled. Considerable pressure for antitrust revision came from the states. A perhaps unlikely leader, Edna Gleason, organized California's retail pharmacists and coordinated trade networks to monitor and enforce Resale Price Maintenance (RPM) contracts, a system of price-fixing, then known as “fair trade.” Progressive jurists, including Louis Brandeis and institutional economist E. R. A. Seligman, supported RPM as a protection to independent proprietors. The breakdown of legal and economic consensus regarding what constituted “unfair competition” allowed businesspeople to act as intermediaries between heterodox economic thought and contested antitrust law, ultimately tailoring federal policy to accommodate state regulations.

The impact of institutional economists in shaping American regulatory tradition has largely been overlooked or dismissed as an incoherent attack on the neoclassical economic paradigm. This essay briefly reconstructs the interwar institutionalist movement, exploring the continuities among heterodox thinkers and the implications for public and private institution-building. It seeks to reorient the history of U.S. political economy towards a deeper understanding of the public-private regulatory tradition that developed in the 1920s through the influence of the institutionalists and other progressive liberals. It emphasizes institutionalists acting within both public administrative agencies, such as the Federal Trade Commission and the Department of Commerce, as well as private research organizations that partnered with business groups and regulatory bodies.

In 1886, the Pennsylvania Supreme Court struck down a law that prohibited employers from paying wages in company store scrip and mandated monthly wage payments. The court held that the legislature could not prescribe mandatory wage contracts for legally competent workingmen. The decision quashed over two decades of efforts to end the “truck system.” Although legislators had agreed that wage payments redeemable only in company store goods appeared antithetical to the free labor wage system, two obstacles complicated legislative action. Any law meant to enhance laborers' rights could neither favor one class over another nor infringe any workingman's ability to make voluntary contracts. These distinctions, however, were not as rigid andlaissez faire-oriented as depicted by conventional history. Labor reformers argued that principles of equity must supplement these categories of class legislation and contract freedom. This essay explores how legal doctrine helped both sides of the anti-truck debate articulate the contested meanings of liberty. Ultimately, theGodcharlesruling enshrined the specialness of workingmen's labor contracts and rejected the use of equity principles to justify contract regulations, but the controversy also informed future labor strategies, especially the turn to state police powers as the rubric under which workers' safety, morals, and health could be protected.

BACKGROUND Nuclear medicine scans may be accompanied by CT acquisitions to provide localization of radioisotope uptake through image fusion and for use in attenuation correction. The effective doses to patients resulting from radioisotope administrations and from diagnostic CT scans are well documented. However, the development of gamma cameras with low dose CT attachments introduces the requirement for calculation of effective doses arising from non-standard CT acquisitions. In this study, the CT function of the GE Infinia Hawkeye was investigated and effective doses were calculated using various methods in order to assess the suitability of standard CT dose calculation methods. METHODS Dose measurements were performed using Perspex head and body phantoms and the results were used in three calculation methods: (1) the ImPACT CT dosimetry calculator used Monte Carlo dose data to calculate effective doses; (2) organ fractions exposed by each scan were estimated and applied to dose measurements and ICRP tissue weighting factors; (3) standard conversion factors were used with measured and displayed dose indices to provide the simplest method of calculation. RESULTS The maximum variation in effective dose using each calculation method was within 10% of the mean. Average effective doses from CT scans acquired using the Hawkeye were 0.9 mSv for a chest scan, 1.5 mSv for an abdomen-pelvis scan, and 0.1 mSv for a head scan, all significantly lower than doses resulting from diagnostic CT scans. CONCLUSION These doses may be used for justification of radiation exposures in accordance with IR(ME)R 2000, in association with the accompanying radioisotope dose.

Administration of a radiopharmaceutical may result in a radiation dose to an infant due to ingestion of the radiopharmaceutical secreted in the breast milk. Following a maternal administration of 5 7 Co labelled to vitamin B 1 2 (cyanocobalamin) as part of a Schilling test an estimate of the absorbed dose to a breast feeding infant was calculated. Milk samples were collected from every feed in the first 24 h, and at approximately 48 and 72 h post-administration. The absorbed dose to the infant's liver (the organ receiving the highest dose) was calculated to be 0.23 mGy. The effective dose to the infant was calculated to be 0.025 mSv, which is considerably lower than the current regulatory limit of 1 mSv. The Administration of Radioactive Substances Advisory Committee advise that the first feed, at approximately 4h after administration, be discarded. The data show that this was unwarranted, and that the peak concentration of 5 7 Co in the breast milk occurred at around 24 h.

Background context Recently the financial relationships between industry and professional medical associations have come under increased scrutiny because of the concern that industry ties may create real or perceived conflicts of interest. Professional medical associations pursue public advocacy as well as promote medical education, develop clinical practice guidelines, fund research, and regulate professional conduct. Therefore, the conflicts of interest of a professional medical association and its leadership can have more far-reaching effects on patient care than those of an individual physician. Purpose Few if any professional medical associations have reported their experience with implementing strict divestment and disclosure policies, and among the policies that have been issued, there is little uniformity. We describe the experience of the North American Spine Society (NASS) in implementing comprehensive conflicts of interest policies. Study design A special feature article. Methods We discuss financial conflicts of interest as they apply to professional medical associations rather than to individual physicians. We describe the current policies of disclosure and divestment adopted by the NASS and how these policies have evolved, been refined, and have had no detrimental impact on membership, attendance at annual meetings, finances, or leadership recruitment. No funding was received for this work. The authors report no potential conflict-of-interest-associated biases in the text. Results The NASS has shown that a professional medical association can manage its financial relationships with industry in a manner that minimizes influence and bias. Conclusions The NASS experience can provide a template for other professional medical associations to help manage their own possible conflicts of interest issues.

Ninety-two children with juvenile rheumatoid arthritis were randomly assigned to treatment in a multicenter, double-blind, 12-week trial designed to compare the efficacy and safety of a liquid formulation of ibuprofen at a dosage of 30 to 40 mg/kg/day versus those of aspirin at a dosage of 60 to 80 mg/kg/day. No significant intergroup differences in response rates or in the amount of improvement in articular indexes of disease activity were observed. More children treated with aspirin discontinued treatment early because of adverse reactions. After this trial, 84 additional patients with juvenile rheumatoid arthritis entered a 24-week, multidose (30, 40, and 50 mg/kg/day), open trial of ibuprofen suspension. Favorable response rates for the three groups were similar, and continued improvement was observed throughout the 24-week period. A dose-response relationship was observed with respect to adverse reactions of the upper gastrointestinal tract. We conclude that ibuprofen suspension is an effective nonsteroidal antlinflammatory drug and that its tolerability in children is acceptable.

Background The use of 90Y for nuclear medicine therapies has steadily increased over the last 10 years. High administered activities are measured in a calibrated re-entrant ionization chamber, while the most sensitive method of assessment of low activities uses a liquid scintillation counter. This method requires the samples to have an acceptably low quench, and therefore heavily coloured samples must undergo chemical processing before assessment. An alternative method has been investigated to measure low activities of 90Y in a sodium iodide well counter by detection of associated Bremsstrahlung. Methods Test samples of 90Y with activities 0.5-730 Bq were measured in a well counter and a liquid scintillation counter, with counting times of 4 h per sample. Both counters were investigated for a relationship between count rate and activity. Results The efficiency of the well counter was found to be 0.08 count x s(-1) x Bq(-1), for a specified vial and sample volume. This is poor compared with the liquid scintillation counter efficiency of 1.0 count x s (-1) x Bq(-1). The uncertainty in measurement of a sample with unknown activity was calculated for a 4 h count time: +/-8.0% at 730 Bq and +/-45% at 6 Bq for the well counter; and +/-8.0% and +/-8.1%, respectively, for the liquid scintillation counter. These errors are dominated by the initial measurement of activity to determine counting efficiency, using a calibrator with an accuracy of +/-8%. If long counting times of both samples and background radiation are practicable, it has been found that a well counter can successfully be used to assess low activities of 90Y.

• Objective. —To determine whether febrile children receiving 2.5-, 5-, or 10-mg/kg ibuprofen therapy via a liquid or 15-mg/kg acetaminophen therapy via an elixir every 6 hours for 24 to 48 hours show equivalent fever reduction or suffer adverse effects of the drug administered. Design. —Randomized, double-blind, multidose, parallel-group, variable-duration (24 to 48 hours) clinical trial. Setting. —The academically affiliated Children's Hospital in Columbus, Ohio. Participants. —64 febrile (defined as oral or rectal temperature of 39°C to 40.5°C) but otherwise healthy children aged 6 months to 11 years 7 months randomly assigned to one of the four drug regimens. Interventions. —Treatment with either ibuprofen or acetaminophen as described above. Administration of antibiotics or intravenous fluids was allowed only after at least 24 hours of treatment with the assigned drug. Measurements/Main Results. —In 61 of the 64 evaluable patients, treatments were effective and well tolerated during the entire study. While the rates of temperature reduction and maximal reduction of fever after administration of the initial dose were equal for patients receiving 10-mg/kg ibuprofen therapy and 15-mg/kg acetaminophen therapy, and both regimens were more effective than smaller doses of ibuprofen in reducing fever, after the second dose (and continuing to the end of the study) there were no statistically significant differences in temperature response among the treatment groups. Six children were withdrawn from the study, two because of dosing errors, three because of hypothermia (temperature of less than 35.6°C; all three patients were in the acetaminophen group), and one because of gastrointestinal distress (this child was in the group receiving 2.5-mg/kg ibuprofen therapy). No other significant symptoms or adverse laboratory or physical findings were noted. While further confirmatory studies are needed, ibuprofen liquid (10 mg/kg) and acetaminophen elixir (15 mg/kg) administered every 6 hours for 24 to 48 hours appeared to be most effective in reducing fever. These two regimens were equally effective and equally tolerated in febrile children. Lower ibuprofen doses (2.5 and 5 mg/kg) were less effective than acetaminophen and 10-mg/kg ibuprofen therapy after the initial dose but were at least equally effective as these two higher-dose regimens thereafter. (AJDC. 1992;146:626-632)

• Objective. —To compare the antipyretic efficacy of ibuprofen, placebo, and acetaminophen. Design. —Double-dummy, double-blind, randomized, placebo-controlled trial. Setting. —Emergency department and inpatient units of a large, metropolitan, university-based, children's hospital in Michigan. Participants. —37 otherwise healthy children aged 2 to 12 years with acute, intercurrent, febrile illness. Interventions. —Each child was randomly assigned to receive a single dose of acetaminophen (10 mg/kg), ibuprofen (7.5 or 10 mg/kg), or placebo. Measurements/Main Results. —Oral temperature was measured before dosing, 30 minutes after dosing, and hourly thereafter for 8 hours after the dose. Patients were monitored for adverse effects during the study and 24 hours after administration of the assigned drug. All three active treatments produced significant antipyresis compared with placebo. Ibuprofen provided greater temperature decrement and longer duration of antipyresis than acetaminophen when the two drugs were administered in approximately equal doses. No adverse effects were observed in any treatment group. Conclusions. —Ibuprofen is a potent antipyretic agent and is a safe alternative for the selected febrile child who may benefit from antipyretic medication but who either cannot take or does not achieve satisfactory antipyresis with acetaminophen. (AJDC. 1992;146:622-625)

A mutant of E. coli K-12 has been isolated which has only 1-3% of the wild-type lysyl-tRNA synthetase activity [L-lysine:tRNA ligase (AMP forming), EC 6.1.1.6]. Additions of 20 mM L-alanine or 6 mM leucine dipeptides to the culture medium can restore the activity of lysyl-tRNA synthetase in the mutant strain to the wild-type level. Experiments on the in vivo charging of lysine tRNA in the mutant show that in the absence of the metabolites lysine tRNA is charged 15-23%. Upon the addition of 3 mM L-leucyl-L-alanine to the medium the lysyl tRNA synthetase activity increases 25-fold and the in vivo charging of lysine tRNA returns to the wild-type level. Experiments with antibody against lysyl-tRNA synthetase show that the stimulation of lysyl-tRNA synthetase activity by the metabolites is the result of new protein synthesis.