Cartel deterrence and settlements: the Brazilian experience

Settlements are an important part of a program of cartel deterrence, particularly when the likelihood of conviction and the litigation costs are higher. This type of negotiated procedure to reach finality is in essence complementary to the fully adversarial procedures associated to the trial by the administrative or judicial courts, and to other investigative instruments, such as the leniency agreement. The Brazilian experience provides some insights about the different models of direct settlement in cartel cases and the complex interaction among settlements, leniency agreements, and trial outcome. First, there is leeway for the complementary models of settlements, the first oriented mainly to increasing the likelihood of detection, and the second oriented to saving social costs of litigation. Second, the concern with the preservation of the demand for leniency agreements led the competition authority to restrict the use of settlements, which are effectively designed for the defendants that are likely guilty and give higher value to finality. The recent experience illustrates that the current settlement policy has not caused any adverse effect on leniency agreements, while reducing litigation costs and granting finality in some cases.

Uma análise da jurisprudência do CADE acerca dos cartéis na revenda de combustíveis

Esta monografia analisa as decisões do Conselho Administrativo de Defesa Econômica (Cade) acerca dos cartéis no setor de revenda de combustíveis, com o objetivo de identificar as características do referido setor que propiciam a formação de cartel, bem como verificar as provas utilizadas como fundamento nas decisões e a participação da Agência Nacional do Petróleo, Gás Natural e Combustível (ANP) na defesa da concorrência no setor. Para introduzir o tema, foram apresentados alguns conceitos relevantes, como “cartel”, “acordo de leniência”, e “termo de compromisso de cessação de conduta”. Em seguida, de modo a delimitar a competência de cada um dos órgãos atuantes no setor, foi realizada uma análise da divisão de competências entre o Cade e a ANP. Dentre os resultados obtidos através de pesquisa processual, com o objetivo de levantar os Processos Administrativos levados a julgamento perante o Cade, foi destacada e aprofundada a análise da participação de Sindicatos como sendo o principal agente na formação de cartéis envolvendo a revenda de combustíveis, os tipos de provas utilizadas nas decisões do órgão antitruste e a valoração dos estudos econômicos realizados pela ANP. A conclusão deste estudo demonstra que os altos números de denúncias envolvendo a prática de cartel no setor são fundadas em indícios insuficientes para uma possível condenação, pois o Cade tem decidido tais casos com base em estudos especializados e provas capazes de comprovar efetivamente a ocorrência de cartel.

A extensão dos efeitos da celebração de Acordo de Leniência com o CADE perante a administração pública

Através do presente trabalho, buscar-se-á analisar os efeitos e a extensão dos benefícios conferidos com a celebração do acordo de leniência com o Conselho Administrativo de Defesa Econômica (“CADE”), principalmente no que se refere à garantia de imunidade quanto às sanções administrativas. Nesse contexto, o presente trabalho procurará verificar se a celebração do acordo de leniência com o CADE extingue a ação punitiva da Administração Pública, ou seja, se nenhum outro ente da Administração Pública direta e indireta pode aplicar qualquer sanção administrativa à empresa leniente. Em outras palavras, se a imunidade prevista na Lei nº 12.529/2011 é restrita ao âmbito do CADE ou engloba toda a Administração Pública. Esse estudo revela-se importante, pois a possibilidade de outro órgão, também integrante da Administração pública, aplicar sanções administrativas à empresa leniente, violaria o sistema punitivo da Administração Pública, visto que o mesmo deve ser analisado e interpretado de maneira uniforme e interligada, além dos incentivos para a celebração do citado acordo de leniência serem reduzidos significativamente, caso outros órgãos da Administração Pública possam aplicar sanções administrativas, como, por exemplo, a declaração de inidoneidade. Portanto, a análise que será desenvolvida neste trabalho de conclusão de curso envolverá institutos e discussões presentes no Direito Administrativo e também no Direito Concorrencial Brasileiro, especificamente no que se refere aos benefícios garantidos com a celebração do acordo de leniência, instituto que foi criado para combater as práticas anticompetitivas colusivas.

Os limites formais para a celebração do acordo de leniência (Lei 12.846/13) em face das garantias do particular

O presente trabalho apresenta um estudo sobre a recente Lei n. 12.846/13, em especial sobre o instituto do acordo de leniência, buscando estabelecer um marco para a celebração desses ajustes tendo em vista os direitos e garantias estabelecidos pela Constituição da República Federativa do Brasil de 1988. Inicialmente, aborda-se as intensas mudanças promovidas no Estado moderno e no direito sancionador de forma geral, questiona-se, em seguida, a existência de um núcleo comum entre o direito penal e o direito administrativo sancionador. Busca-se, por fim, propor soluções para maximizar a eficácia do sistema de controle e sanção da Lei n. 12.846/13, tendo em vista a necessidade de se harmonizar a Regulação Pública com a segurança jurídica e os direitos constitucionais da pessoa jurídica investigada, em especial quando ela celebra o acordo de leniência.

Diagnostic agreement between panoramic radiographs and color doppler images of carotid atheroma

The aim of this study was to investigate the agreement between diagnoses of calcified atheroma seen on panoramic radiographs and color Doppler images. Our interest stems from the fact that panoramic images can show the presence of atheroma regardless of the level of obstruction detected by color Doppler images. Panoramic and color Doppler images of 16 patients obtained from the archives of the Health Department of the city of Valença, RJ, Brazil, were analyzed in this study. Both sides of each patient were observed on the images, with a total of 32 analyzed cervical regions. The level of agreement between diagnoses was analyzed using the Kappa statistics. There was a high level of agreement, with a Kappa value of 0.78. In conclusion, panoramic radiographs can help detecting calcifications in the cervical region of patients susceptible to vascular diseases predisposing to myocardial infarction and cerebrovascular accidents. If properly trained and informed, dentists can refer their patients to a physician for a cardiovascular evaluation in order to receive proper and timely medical treatment.

Observer agreement of spine stenosis on magnetic resonance imaging analysis of patients with cervical spine myelopathy

Objectives: The purpose of this study was to measure the intraobserver and interobserver reliability of magnetic resonance detection of cervical spondylotic myelopathy with and without operational guidelines. Methods: Seven radiologists examined images from 10 patients with cord signal abnormalities and clinical signs of myelopathy. Radiologist examined films twice, with and without operational guidelines designed to define stenotic changes, while blinded to the clinical findings of the patients. Analyses included a Fleiss kappa assessment of intraobserver and interobserver reliability. Results: Results demonstrated high percentage of agreement and strong intraobserver reliability and variable Fleiss kappa, values for interobserver assessment. Operational guidelines did not improve the intraobserver or interobserver agreement. Conclusion: Although the percentage of agreement was high in some cases, the kappa agreement was low-most likely a result of the base rate problem of a kappa analysis. Sample bias toward severe degenerative changes resulted in highly prevalent selections and kappa adjusted values. Nonetheless, the results do suggest that substantial intraobserver kappa agreement and a wide range of interobserver kappa agreement exists among trained radiologists during detection of stenotic changes associated with cervical spondylotic myelopathy.

Screening Anal Dysplasia in HIV-Infected Patients: Is There an Agreement Between Anal Pap Smear and High-Resolution Anoscopy-Guided Biopsy?

PURPOSE: The purpose of this study was to analyze the agreement between anal Pap smear and high-resolution anoscopy-guided biopsy in diagnosing anal dysplasia in HIV-infected patients. METHODS: We conducted cross-sectional analysis of HIV-infected patients receiving anal dysplasia screening as part of routine care. Agreement between measures was estimated by weighted kappa statistics, using a three-tiered cytologic and histologic grading system (normal, low-grade dysplasia, and high-grade dysplasia). Estimates of sensitivity, specificity, and predictive values were calculated using a two-tiered cytologic and histologic grading system (""without dysplasia"" and ""with dysplasia of any grade""). Estimates were also calculated for the detection of high-grade dysplasia. RESULTS: During a one-year period, 222 patients underwent 330 anal Pap smears followed by high-resolution anoscopy-guided biopsies. There were 311 satisfactory Pap smears with concurrent biopsies. Considering histology the standard, the frequency of anal dysplasia was 46%. Kappa agreement between anal Pap smear and biopsy was 0.20. For detection of anal dysplasia of any grade, anal Pap smear showed sensitivity of 61%, specificity of 60%, positive predictive value of 56%, and negative predictive value of 64%. For high-grade dysplasia, anal Pap smear showed sensitivity of 16% and specificity of 97%. CONCLUSION: Anal Pap smears alone were not sensitive enough to rule out anal dysplasia. We recommend that high-resolution anoscopy-guided biopsy be incorporated as a complementary screening test for anal dysplasia in high-risk patients. Following baseline high-resolution anoscopy, these individuals could be followed with serial anal cytology to dictate the need for future high-resolution anoscopy-guided biopsies.

Agreement for Detecting Glaucoma Progression with the GDx Guided Progression Analysis, Automated Perimetry, and Optic Disc Photography

Purpose: To evaluate the ability of the GDx Variable Corneal Compensation (VCC) Guided Progression Analysis (GPA) software for detecting glaucomatous progression. Design: Observational cohort study. Participants: The study included 453 eyes from 252 individuals followed for an average of 46 +/- 14 months as part of the Diagnostic Innovations in Glaucoma Study. At baseline, 29% of the eyes were classified as glaucomatous, 67% of the eyes were classified as suspects, and 5% of the eyes were classified as healthy. Methods: Images were obtained annually with the GDx VCC and analyzed for progression using the Fast Mode of the GDx GPA software. Progression using conventional methods was determined by the GPA software for standard automated achromatic perimetry (SAP) and by masked assessment of optic disc stereophotographs by expert graders. Main Outcome Measures: Sensitivity, specificity, and likelihood ratios (LRs) for detection of glaucoma progression using the GDx GPA were calculated with SAP and optic disc stereophotographs used as reference standards. Agreement among the different methods was reported using the AC(1) coefficient. Results: Thirty-four of the 431 glaucoma and glaucoma suspect eyes (8%) showed progression by SAP or optic disc stereophotographs. The GDx GPA detected 17 of these eyes for a sensitivity of 50%. Fourteen eyes showed progression only by the GDx GPA with a specificity of 96%. Positive and negative LRs were 12.5 and 0.5, respectively. None of the healthy eyes showed progression by the GDx GPA, with a specificity of 100% in this group. Inter-method agreement (AC1 coefficient and 95% confidence intervals) for non-progressing and progressing eyes was 0.96 (0.94-0.97) and 0.44 (0.28-0.61), respectively. Conclusions: The GDx GPA detected glaucoma progression in a significant number of cases showing progression by conventional methods, with high specificity and high positive LRs. Estimates of the accuracy for detecting progression suggest that the GDx GPA could be used to complement clinical evaluation in the detection of longitudinal change in glaucoma. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. Ophthalmology 2010; 117: 462-470 (C) 2010 by the American Academy of Ophthalmology.

Agreement between stress intraocular pressure and long-term intraocular pressure measurements in primary open angle glaucoma

The aim of this paper is to study the correlation between the intraocular pressure peaks and fluctuation detected during the water drinking test and the same parameters observed during long-term follow up. This prospective cohort study enrolled 22 eyes of 22 newly diagnosed primary open angle glaucoma patients. After an initial complete ophthalmological examination, patients were started on antiglaucoma medication and returned 4 weeks later to perform the water drinking test. Thereafter, patients were evaluated at least eight times within a period of 6-12 months. The intraocular pressure peaks and fluctuation detected during the water drinking stress test were compared with those observed during regular office visits. Spearman`s correlation coefficient and Bland-Altman Plots were used for statistical analysis. The mean age of participants was 54.3 +/- 8.2 years (+/- SD), 59% were women, and average mean deviation -10.2 +/- 4.5 dB. The mean follow-up period was 8.2 +/- 2.0 months. The average intraocular pressure peaks and fluctuation during the water drinking test were 20.0 +/- 2.9 mmHg and 40 +/- 10%, respectively, and 18.1 +/- 2.8 mmHg and 30 +/- 10% during follow up. Spearman`s correlation coefficients were significant and strong between the intraocular pressure peaks and fluctuation detected during the water drinking test and during the follow-up period (P < 0.001, rho = 0.76 and 0.82, respectively). There was good agreement between the variables. The intraocular pressure peaks and fluctuation detected during the water drinking test showed significant correlation and agreement with the pressures observed during follow-up visits. Stress tests could be used to estimate long-term intraocular pressure variation.

No correlation and low agreement of imaging and inflammatory atherosclerosis` markers in familial hypercholesterolemia

Our purpose was to study the determinants of coronary and carotid subclinical atherosclerosis, aortic stiffness and their relation with inflammatory biomarkers in familial hypercholesterolemia (FH) subjects. Furthermore, we evaluated the agreement degree of imaging and inflammatory markers` severity used for coronary heart disease (CHD) prediction. Coronary calcium scores (CCS), carotid intima media thickness (IMT), carotid-femoral pulse wave velocity (PWV), C reactive protein (CRP) and white blood cells count (WBC) were determined in 89 FH patients (39 +/- 14 years, mean LDL-C=279 mg/dl) and in 31 normal subjects (NL). The following values were considered as imaging and biomarkers` severity: CCS > 75th% for age and sex, IMT > 900 mu m, PWV > 12 m/s, and CRP > 3 mg/l. Coronary artery calcification (CAC) prevalence and severity, IMT, PWV and WBC values were higher in FH than in NL (all parameters, p < 0.05). After multivariate analysis, the following variables were considered independent determinants of (1) IMT: systolic blood pressure, 10-year CHD risk by Framingham risk scores (FRS) and apolipoprotein B (r(2)=0.33); (2) PWV: age (r(2)=0.35); (3) CAC as a continuous variable: male gender and LDL-cholesterol year score (LYS) (r(2)=0.32); (4) presence of CAC as dichotomous variable: FRS (p=0.0027) and LYS (p=0.0228). With the exception of a moderate agreement degree between IMT and PWV severity (kappa=0.5) all other markers had only a slight agreement level (kappa < 0.1). In conclusion, clinical parameters poorly explained IMT, CAC and PWV variability in FH subjects. Furthermore, imaging markers and inflammatory biomarkers presented a poor agreement degree of their severity for CHD prediction. (C) 2007 Elsevier Ireland Ltd. All rights reserved.