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Objectives To measure rates of potentially inappropriate pathology testing in the hospital setting. Methods Retrospective cross-sectional study in hospital setting from July 2021 to December 2021. We examined 3 potentially inappropriate uses: overordering, selection errors, and unnecessary repeat testing. Overordering included vitamin D and lipids (rarely required in acute hospital care). Selection error was the ratio of iron studies to standalone ferritin requests. Unnecessary repeats included any repeat vitamin D, lipids, iron, or ferritin in an episode of care or C-reactive protein (CRP) repeated within 3 days and N-terminal pro–brain natriuretic peptide (NT-proBNP) within 7 days and repeated previously abnormal CRP and NT-proBNP tests. Costs of inappropriate tests were estimated using the Australian Medicare Benefits Schedules. Results Among 55,904 test requests, 15% (n = 8120) were potentially inappropriate. Vitamin D was frequently ordered (n = 4498), as were lipids (n = 2872). Ratio of iron studies to standalone ferritin was 36. Of 19,233 repeat CRPs, 36% (n = 6947) were within 3 days and 62% (n = 179) of repeat NT-proBNPs were within 7 days of the first test. For initially abnormal tests, 89% of CRPs and 97% of NT-proBNPs remained abnormal. Inappropriate test costs accounted for 12% to 30% of costs. Conclusions Frequent potential inappropriate use and selection of pathology tests was observed in South Australian hospitals. [ABSTRACT FROM AUTHOR]

Both Google Android and Google Search (Shopping), along with other ongoing digital market antitrust enforcement actions like United States v. Google LLC, are based on foreclosure conduct that has raised difficult doctrinal questions for courts, regulators, and scholars. This emerging form of foreclosure, which some have termed "cognitive foreclosure" because of its behavioural economic foundations, has encountered difficulties in being conceptually subsumed under existing antitrust frameworks. Yet as a demand-side market failure, enforcers and scholars must be cautious about automatically categorising these market failures as antitrust issues, given that such market failures are usually governed by the more de-minimis consumer protection regime. This Article proffers a new legal test to aid courts and regulators in appropriately "identifying" behavioural market failures that would justify antitrust scrutiny. The test's limits are subsequently justified from moral hazard perspectives given the potential reduction in societal rationality due to antitrust over-enforcement. [ABSTRACT FROM AUTHOR]

Digital markets now fundamentally intertwine with our social and economic lives. International enforcement actions--the United States (U.S.) and European Union (E.U.) Google cases in particular--demonstrate from a behavioral economic perspective how digital platforms may be beginning to implicate antitrust's two most fundamental doctrinal components--conduct and market power--in nuanced ways. In short, the regulatory and policy landscape showcases that we may be moving closer towards an antitrust world whereby firms can manipulate consumers' psychological shortcomings to foreclose competition--a new form of nefarious conduct that might appropriately be termed "cognitive foreclosure." Yet as a demand-side market failure, one should be cautious about categorizing behavioral market failures as antitrust issues. The behavioral deviation from perfect competition, then, would need to be "substantial" and "sustainable" if such market failures are to justifiably attract antitrust scrutiny. [ABSTRACT FROM AUTHOR]

Estrogen deficiency-induced bone loss is associated with complex changes in the calcium fluxes that constitute calcium balance. We studied the effects of oophorectomy on calcium balance and its components within the first 9 wk after the operation. Six-day calcium balance studies were performed on 30-wk-old female Sprague-Dawley rats before either sham operation or oophorectomy (oophx) and at 3-wk intervals for 9 wk postoperation. The rats were fed a diet containing 0.4g Ca/100 g diet and 0.3 g P/100 g diet throughout the study. The postoperative changes in calcium balance (P < 0.05) and net calcium absorption (P < 0.02) were negative in the oophx group compared with the ovary-intact group. The oophx group excreted more calcium via both the kidney (urine Ca, P < 0.05) and the gastrointestinal tract (endogenous fecal Ca, P < 0.05). The postoperation endogenous fecal calcium was higher at 3 wk postoophorectomy than at later times (P < 0.05). Oophorectomy did not affect true calcium absorption up to 9 wk postoophorectomy. Oophorectomy stimulates bone metabolism and our findings indicate that within the first 9 wk after oophorectomy, bone mineral loss is associated with a transient increase in the excretion of calcium by the gastrointestinal tract and the kidney. KEY WORDS: * oophorectomy * rat * calcium balance * calcium excretion.

Calcium balance and its major components (true calcium absorption, urinary calcium excretion and intestinal calcium secretion) were assessed by a 6-d balance technique in young (6-wk-old) rats fed a diet containing 7.2 g Ca/kg diet. Following either oophorectomy (oophx) or sham operation, the balance study was repeated at 9, 12 and 15 wk of age. Calcium balance decreased with age but remained positive in each group (mean (pooled SEM): sham, (6 wk) 0.86 to (15 wk) 0.27 (0.03) mmol/d (P < 0.0001); oophx, (6 wk) 0.91 to (15 wk) 0.22 (0.03) mmol/d (P < 0.0001)). Analysis of variance of the change in calcium balance indicated that there was a significantly greater reduction in calcium balance in the oophx group compared with the sham-operated group. Intestinal calcium absorption decreased in each group with age (sham: (6 wk) 46.3% to (15 wk) 22.6% (1.5%) (P < 0.0001); oophx: (6 wk) 48.2% to (15 wk) 21.2% (1.5%) (P < 0.0001)). There was a marked rise in intestinal calcium secretion in the oophx group compared with the sham-operated group at 6 wk post-operation (12 wk of age) (oophx: 0.33 (0.02) mmol/d; sham: 0.23 (0.02) mmol/d (P < 0.01)). Urinary calcium excretion was not affected by either age or oophorectomy. We conclude that oophorectomy in young rats leads to a reduction in calcium accumulation, which is mainly the result of an increase in intestinal calcium secretion.

This study sought to determine patterns of multimorbidity and quantify their impact on use of primary health services in the presence and absence of anxiety and depression among a cohort of urban community-dwelling men in Australia. The analytic sample consisted of men (n = 2039; age 38–85) from the follow-up wave of a prospective cohort study of all participants of the Florey Adelaide Male Ageing Study (FAMAS; Stage 2 [2007–2010]) and age-matched men from the North-West Adelaide Health Study (NWAHS; Stage 3 [2008–2010]). Self-reported data and linkage with a national universal health coverage scheme (Medicare) provided information on the prevalence of eight chronic conditions and health service utilization information (including annual GP visits). Obesity and cardiovascular disease (CVD) were associated with the highest number of comorbid conditions. Two nonrandom multimorbidity “clusters” emerged: “CVD, Obesity, Diabetes” and “CVD, Obesity, Osteoarthritis.” Participants with conditions comorbid with CVD were more likely to have 10 or more annual GP visits, compared to multimorbidity involving other conditions. In comparison to participants without CVD, the presence of CVD increased the chance of having 10 or more annual GP visits (adjusted risk ratio: 3.7; 95% CI [2.8, 4.8]). When CVD was comorbid with anxiety and depression, having 10 or more annual GP visits was more common (adjusted risk ratio: 1.8; 95% CI [1.2, 2.5]). Multimorbidity patterns involving CVD, especially for multimorbidity that includes CVD with comorbid anxiety and depression, should be considered in developing clinical trials to better inform medical decision-making and care for patients with CVD and comorbid conditions. [ABSTRACT FROM AUTHOR]

The European Commission relies heavily on its leniency program for the public enforcement of Anti trust law, This program incentivizes a cartelist to come clean to the European Commission by offering immunity from. or a reduction in. sanctions that would otherwise be imposed for its participating in a cartel. The Commission is also keen to promote the private enforcement of Antitrust law, as evidenced by Council and Parliament Directive 2014/104/EU on certain rules governing actions for damages under national law for infringements of the competition law provisions of the Member States and of the European Union There are concerns. however. that tm increase in private enforcement will significantly curtail the efficacy of public enforcement. Indeed, if prospective leniency applicants anticipate that the evidence submitted for a leniency application will be used against them in a future damages action. the attractiveness of applying for leniency diminishes. Public antitrust enforcement's effectiveness would then be significantly reduced, Drawing on experiences from the United States and agency theory" from corporate governance, this note argues for the introduction of criminal penalties at the EU level as a solution to the public-private antitrust enforcement conflict. Specifically this note shows that the existence of individual criminal sanctions. coupled with the possibility of immunity from such sanctions. affects a firm's cost-benefit analysis when considering a leniency application--such that a firm is forced to come forward even if a damages action is likely, The note also analyses the possible legal bases for the introduction of antitrust criminalization at the EU level. [ABSTRACT FROM AUTHOR]