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Appraisal is a legislatively created right for shareholders to seek a judicial determination of the fair value of their stock in certain transactions. For many decades, appraisal was a little-used and frequently maligned corporate law remedy. Beginning at the turn of the twenty-first century, this all changed when a group of financial investors, including some hedge funds, began filing appraisal cases. Appraisal arbitrage, as it became known, grew rapidly in popularity. Appraisal arbitrage's success soon attracted negative attention. In 2016, the Delaware legislature amended its appraisal statute to eliminate most small shareholders' appraisal rights and to permit companies to prepay merger consideration to appraisal petitioners. In 2017, the Delaware Supreme Court issued two important decisions emphasizing that deal price was the primary measure of fair value for lower courts to use in appraisal proceedings. Appraisal filings plummeted soon thereafter. In this Article, we seek to empirically explain the rise and fall of appraisal arbitrage using data from 2000-2019. For the period 2015-2019, we find that the average deal gross return to appraisal arbitrage is 13.2%--far less than the 98.2% average for the 2000-2014 period. Looking at the main components of these returns, we find that, on average, prejudgment interest accrual generated total returns of 18.1% for appraisal petitioners from 2015-2019. However, the difference between the judicially determined fair price minus the deal price averages negative 5.3%. While both of these numbers are sharply lower than those in the pre-2015 era, the drop in judicial value improvement is especially large. We conclude that the principal reasons for the decline of appraisal arbitrage were the Delaware Supreme Court's 2017 opinions. [ABSTRACT FROM AUTHOR]

Background: Prior studies suggest structurally integrating healthcare organizations may not yield care that is integrated for patients. This research has been limited by lack of comprehensive measures of integrated patient care. Our study establishes an evidence base of care integration from the patient's perspective among a national sample in the United States using a reliable and valid survey. We explore the relationship between patientperceived integration and elements of organizational integration among medical groups. Methods: We refined and administered the Patient Perceptions of Integrated Care (PPIC) survey. It was theoretically derived, refined through pilot-testing, cognitive testing, and advisory panel input, and tested for reliability and validity. Psychometric analysis supported six dimensions of patient-perceived integration: (1) Provider Knowledge of the Patient, (2) Staff Knowledge about the Patient's Medical History, (3) Specialist Knowledge about the Patient's Medical History, (4) Support for Self-directed Care, (5) Support for Medication and Home Health Management, and (6) Test Result Communication. We also created an index of Integration following Hospitalization. This structure achieved good model fit and internal, discriminant, and construct validity. We administered the survey across a stratified random sample of 12,364 Medicare beneficiaries with at least two chronic conditions who had received care from a sample of 150 medical groups from the National Study of Physician Organizations (NSPO3). The final sample included 3,067 Medicare beneficiaries (26% response after 412 exclusions). We extracted data on the medical groups from the NSPO3 for five dichotomized dimensions: large/small size, physician/hospital ownership, primary care/multi-specialty, an information technology sophistication index related to electronic medical record and eprescribing use (high/low), and an index regarding key care management process intensity (high/low). We conducted analyses using ordered logistic regression models with robust standard errors and weighting by response probability, adjusting for patient demographic, health and psychological characteristics. Results: Among the seven dimensions of integration, Test Result Communication exhibited the most consistently positive responses; each of its three items had over 70% of respondents reporting the most favorable option. Support for Self-directed Care and Support for Medication and Home Health Management exhibited consistently the least favorable responses. For Support for Self-directed Care, none of its five items had more than half of responses in the most favorable option, and four of the five items had over 20% of responses in the least favorable option. For Support for Medication and Home Health Management, only one of its four items revealed a majority in the most favorable option (at 55%). We did not find evidence of strong, consistent relationships between medical group characteristics and integrated care from the patient's perspective. Being a patient in a multispecialty group was associated with higher patient-perceived integration in all domains except for test result communication, but only the relationship with staff knowledge was statistically significant (odds ratio = 1.70; p<.05). There were no strong relationships between perceived integration and either hospital ownership or technological capabilities (odds ratios ranging from 0.99 to 1.01). As compared to patients of large medical groups, patients of both solo practices and small groups had greater odds of being in a higher quartile for provider knowledge, staff knowledge, and support for medication and home health management (the latter was statistically significant; odds ratio = 1.35; p<.01). There was a negative relationship between care management and test result communication for large groups, but a positive relationship for small and solo groups (chow test p =.002). Discussion: According to respondents in this national survey, many opportunities exist to better integrate care for patients with multiple chronic conditions. Notably, the two dimensions exhibiting the lowest levels of integration both related to how well providers support patients in participating in their own care. Particularly for patients with complex illnesses, who require care at home and often face barriers to receiving it, this gap signals an important opportunity for investment and improvement. Our results indicate that opportunities to better integrate care exist for all organizations. No single organizational feature was associated with stronger integration across all dimensions. Conclusion: This research suggests that producing truly integrated care may be more complex than can be captured by simple measures of organizational structure, function and process. Considering patient-perceived assessments of care integration is critical to understanding delivery system transformation. [ABSTRACT FROM AUTHOR]

The Securities and Exchange Commission (SEC) is currently considering a rulemaking petition requesting that the Commission shorten the ten-day window, established by Section 13(d) of the Williams Act, within which investors must publicly disclose purchases of a five percent or greater stake in public companies. In this Article, we provide the first systematic empirical evidence on these disclosures and find that several of the petition's factual premises are not consistent with the evidence. Our analysis is based on about 2,000 filings by activist hedge funds during the period of 1994-2007. We find that the data are inconsistent with the petition's key claim that changes in market practices and technologies have operated over time to increase the magnitude of pre-disclosure accumulations, making existing rules "obsolete" and therefore requiring the petition's proposed "modernization." The median stake that these investors disclose in their 13(d) filings has remained stable throughout the 17-year period that we study, and regression analysis does not identify changes over time in the stake disclosed by investors. We also find that: * A substantial majority of 13(d) filings are actually made by investors other than activist hedge funds, and these investors often use a substantial part of the ten-day window before disclosing their stake. * A significant proportion of poison pills have low thresholds of 15% or less, so that management can use 13(d) disclosures to adopt low-trigger pills to prevent any further stock accumulations by activists--a fact that any tightening of the SEC's rules in this area should take into account. * Even when activists wait the full ten days to disclose their stakes, their purchases seem to be disproportionately concentrated on the day they cross the threshold and the next day; thus, the practical difference in pre-disclosure accumulations between the existing regime and the rules in jurisdictions with shorter disclosure windows is likely much smaller than the petition assumes. * About ten percent of 13(d) filings seem to be made after the ten-day window has [ABSTRACT FROM AUTHOR]

The KIR complex appears to be evolving rapidly in humans, and more than 50 different haplotypes have been described, ranging from four to 14 KIR loci. Previously it has been suggested that most KIR haplotypes consist of framework genes, present in all individuals, which bracket a variable number of other genes. We used a new technique to type 793 families from the United Kingdom and United States for both the presence/absence of all individual KIR genes as well as copy number and found that KIR haplotypes are even more complex. It is striking that all KIR loci are subject to copy number variation (CNV), including the so-called framework genes, but CNV is much more frequent in KIR B haplotypes than KIR A haplotypes. These two basic KIR haplotype groups, A and B, appear to be following different evolutionary trajectories. Despite the great diversity, there are 11 common haplotypes, derived by reciprocal recombination near KIR2DL4, which collectively account for 94% of KIR haplotypes determined in Caucasian samples. These haplotypes could be derived from combinations of just three centromeic and two telomeric motifs, simplifying disease analysis for these haplotypes. The remaining 6% of haplotypes displayed novel examples of expansion and contraction of numbers of loci. Conventional KIR typing misses much of this additional complexity, with important implications for studying the genetics of disease association with KIR that can now be explored by CNV analysis. [ABSTRACT FROM AUTHOR]

Genetic diversity information will be very valuable for future rapeseed (Brassica napus L.) improvement. The genetic diversity and relationships among 92 rapeseed accessions, including 44 from China, 22 from Europe, 16 from the United States, and 10 from Canada, were assessed by 60 random amplified polymorphic DNA (RAPD) and 22 expressed sequence tag (EST)-simple sequence repeat (SSR) primers. In total, 618 RAPD and 117 EST-SSR polymorphic fragments were detected. The average number of polymorphic fragments found by each RAPD primer was 10.3 ranging from 3 to 17 and that detected by each pair of EST-SSR primer was 5.3 ranging from 4 to 7. The unweighted pair-group method with arithmetic mean (UPGMA) cluster analysis revealed that these 92 accessions could be classified into three major clusters. Cluster I consisted of accessions mainly from China, which belong to the semi-winter type. Cluster II contained accessions from Europe and the United States, which belong to the winter type. Cluster III was a semi-winter and spring type mixture group, which contained accessions mainly from China and Canada. The principal component analysis and population structure analysis revealed similar results to the cluster analysis. Analysis of molecular variance result based on four geographic groups indicated that genetic variation was 8.24% among populations of geographic regions and 91.76% within geographic regions. Rapeseed accessions from the United Stated have the greatest genetic distance from accessions of other geographic origins, especially those from China. United States rapeseed could be important germplasm resources for enriching the genetic background of Chinese rapeseed and vice versa. [ABSTRACT FROM AUTHOR]

The article discusses a study conducted to know whether physicians, the group most familiar with end-of-life care, receive higher or lower intensity end-of-life treatments in comparison with nonphysicians. The study found that physicians received significantly less intensive care than the general population for 3 of 5 end-of-life care intensity measures and study limitations include omission of unmeasured confounders by controlling hospital referral region.

Examines the prevalence of depression in patients with congestive heart failure (CHF) in New York. Use of logistic regression in determining the prognostic value of depression; Correlation of depression with increased mortality; Factors considered in the readmission of patients with CHF.