Coinfection of a bearded dragon, Pogona vitticeps, with adenovirus- and dependovirus-like viruses.

Four neonate bearded dragons, Pogona vitticeps, from two collections became ill and died. Multiple tissues were collected and processed for light microscopy. In hematoxylin and eosin-stained sections of liver of one lizard, numerous basophilic intranuclear inclusions were observed. In three lizards, intranuclear inclusions were primarily seen within enterocytes in the small intestine. A portion of paraffin-embedded liver of one lizard and small intestine of a second lizard were removed, deparaffinized, and examined by electron microscopy. For the most part, inclusions in the liver consisted of nonenveloped viral particles 60-66 nm in diameter. Smaller nonenveloped virions 15-17 nm in diameter were occasionally seen in association with these particles. In the intestine, inclusions consisted only of 60-70 nm particles. Based on morphology and location, the larger particles were consistent with an adenovirus. Based on size and presence within nuclei of host cells coinfected with the adenovirus-like virus, the smaller viral agent was consistent with members of the genus Dependovirus.

The legal framework for effective competition.

Largely because of its indifference to spiraling costs, the professional domination model is being replaced by a market model based on competition among managed care plans and integrated delivery systems. In general, the more fully integrated previously competing providers become--for instance, by assuming financial risk together--the less legal risk is present, because of a decreased possibility of improper conspiratorial or collective behavior. Nevertheless, provider joint ventures and integrated delivery systems face a complex interaction of practical challenges and various legal and regulatory risks. This chapter explores ways in which laws involving fraud and abuse, self-referral, private inurement, corporate practice of medicine, Medicare reimbursement policy, and antitrust enforcement affect typical integrated delivery systems. From a legal standpoint, it might seem logical that the laws regulating health care providers would support and promote integration. A permissive legal environment to foster development of an integrated service network model assumes its development in a delivery system in which networks are at financial risk for the services provided. However, many of the laws and regulations governing integrated provider development were established at a time when joint ventures and other alliances were organizing in a predominantly fee-for-service environment and were generating significant increases in health care costs without producing demonstrable efficiencies or quality enhancements. The results is a fundamental inconsistency in government policy. The demand for collaboration by purchasers and legislatures does not necessarily cause the vast body of health care regulators to revise their concerns that many of the very collaborative activities being encouraged trigger potentially illegal acts and relationships. In a market model, the application of federal and state antitrust laws is especially important. In 1993 and 1994, the Department of Justice and the Federal Trade Commission jointly issued "Statements of Antitrust Enforcement Policy" in a number of areas of provider uncertainty. For integrated delivery systems, the primary focus of antitrust analysis is "market power." Systems without market power (i.e., the ability to force a purchaser to do something that the purchaser would not do in a competitive market) cannot harm consumers and should be free from serious antitrust risk. Where a network may have market power, its activities may be limited only if demonstrable anticompetitive effects outweigh the benefits of the efficiencies claimed by the new arrangement. The chapter concludes that vigorous antitrust enforcement may be required to promote market competition among integrated networks of providers and the managed care plans they serve.

A description of Isospora amphiboluri (Apicomplexa: Eimeriidae) from the inland bearded dragon, Pogona vitticeps (Sauria: Agamidae).

Fecal samples from 50 captive inland bearded dragons, Pogona vitticeps (Ahl, 1926), bred in California, were examined for coccidian parasites. Sixteen (32%) of the lizards were found to be passing oocysts of Isospora amphiboluri Cannon, 1967, previously described from bearded dragons Pogona barbata (Cuvier, 1829) from Australia. Sporulated oocytes were spherical to subspherical, 25.3 x 25.1 (23-26 x 23-26) microns, with a shape index (length/width) of 1.0 (1.0-1.1). A micropyle, oocyst residuum, and polar granule were absent. Sporocyts were ovoidal, 17.0 x 11.4 (16-18 x 11-12) microns, with a shape index of 1.5 (1.4-1.7). A sporocyst residuum, Stieda, and substieda bodies were present, but parastieda bodies were absent. Sporozoites were elongated, 13.9 x 3.5 (12-15 x 3-4) microns in situ, containing spherical anterior and posterior refractile bodies. The occurrence of I. amphiboluri in P. vitticeps is a new host and geographic record for the parasite. Photomicrographs of the oocysts and endogenous life cycle stages of I. amphiboluri are presented for the first time.

Joint antitrust enforcement policy: a first step, but questions remain.

The Department of Justice and the Federal Trade Commission have jointly issued statements of antitrust enforcement policy" in six health care areas. In addition, the agencies have committed themselves to responding to any request for more specific guidance in the six areas within 90 days. Although the conduct in the request must be proposed, not actual, the new expedited review period is nevertheless a potentially attractive option not previously available.

Toward a definitive antitrust standard for nonprofit hospital mergers.

Despite decades of federal and state regulatory efforts to encourage more efficient utilization of hospital resources, recent federal antitrust enforcement actions assert that nonprofit hospital mergers are detrimental to consumers. This policy, however, is derived from misguided attempts to apply the economic assumptions of for-profit industries to the nonprofit hospital sector and to extend statutes enacted to restrain national economic concentration to local nonprofit enterprises. This paper concludes that a rational antitrust enforcement policy that recognizes the unique characteristics of hospital markets can be described within the confines of existing antitrust statutes.

Disease and cure: the professional liability crisis.

Many of the issues surrounding the so-called liability crisis are not in dispute. However, the parties involved to differ significantly in their approaches to solutions to the problem.

A practical guide to health care antitrust issues.

This article provides a brief overview of antitrust principles that are applicable to the health care industry, and applies those principles to some major antitrust issues that hospitals currently face.

Appropriateness review: still an ill-defined process.

In their rush to criticize appropriateness review, hospitals should not lose sight of its possible advantages, e.g., protection against antitrust attack.