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Certificate of need (CON) laws limit the supply of health care services in about two-thirds of U.S. states. The regulations require those who wish to offer new services or expand existing services to first prove to a regulator that the care is needed. While advocates for the regulation have offered several rationales for its continuance, the balance of evidence suggests that the rules protect incumbent providers from competition at the expense of patients, payors, and would-be competitors. In this article, I review the history of CON laws in health care, summarize the large literature evaluating them, and briefly sketch options for reform. JEL Classification: I11, I18, H75

The impact of ocean warming on fish and fisheries is vigorously debated. Leading theories project limited adaptive capacity of tropical fishes and 14-39% size reductions by 2050 due to mass-scaling limitations of oxygen supply in larger individuals. Using the world’s hottest coral reefs in the Persian/Arabian Gulf as a natural laboratory for ocean warming - where species have survived >35.0 °C summer temperatures for over 6000 years and are 14-40% smaller at maximum size compared to cooler locations - we identified two adaptive pathways that enhance survival at elevated temperatures across 10 metabolic and swimming performance metrics. Comparing Lutjanus ehrenbergii and Scolopsis ghanam from reefs both inside and outside the Persian/Arabian Gulf across temperatures of 27.0 °C, 31.5 °C and 35.5 °C, we reveal that these species show a lower-than-expected rise in basal metabolic demands and a right-shifted thermal window, which aids in maintaining oxygen supply and aerobic performance to 35.5 °C. Importantly, our findings challenge traditional oxygen-limitation theories, suggesting a mismatch in energy acquisition and demand as the primary driver of size reductions. Our data support a modified resource-acquisition theory to explain how ocean warming leads to species-specific size reductions and why smaller individuals are evolutionarily favored under elevated temperatures. The impact of ocean warming on fish size structure is debated. Here, the authors test mass scaling of metabolism and swimming performance of fish across different water temperatures and regions, suggesting that resource-acquisition explains size reduction due to ocean warming.

Fishes are known to use chemical alarm cues from both conspecifics and heterospecifics to assess local predation risks and enhance predator detection. Yet it is unknown how recognition of heterospecific cues arises for coral reef fishes. Here, we test if naïve juvenile fish have an innate recognition of heterospecific alarm cues. We also examine if there is a relationship between the intensity of the antipredator response to these cues and the degree to which species are related to each other. Naïve juvenile anemone fish, Amphiprion percula, were tested to see if they displayed antipredator responses to chemical alarm cues from four closely related heterospecific species (family Pomacentridae), a distantly related sympatric species (Asterropteryx semipunctatus) and a saltwater (control). Juveniles displayed significant reductions in foraging rate when exposed to all four confamilial heterospecific species but they did not respond to the distantly related sympatric species or the saltwater control. There was also a strong relationship between the intensity of the antipredator response and the extent to which species were related, with responses weakening as species became more distantly related. These findings demonstrate that chemical alarm cues are conserved within the pomacentrid family, providing juveniles with an innate recognition of heterospecific alarm cues as predicted by the phylogenetic relatedness hypothesis.

Prey individuals with complex life-histories often cannot predict the type of risk environment to which they will be exposed at each of their life stages. Because the level of investment in defences should match local risk conditions, we predict that these individuals should have the ability to modulate the expression of an integrated defensive phenotype, but this switch in expression should occur at key life-history transitions. We manipulated background level of risk in juvenile damselfish for four days following settlement (a key life-history transition) or 10 days post-settlement and measured a suite of physiological and behavioural variables over 2 weeks. We found that settlement-stage fish exposed to high-risk conditions displayed behavioural and physiological alterations consistent with high-risk phenotypes, which gave them a survival advantage when exposed to predators. These changes were maintained for at least 2 weeks. The same exposure in post-settlement fish failed to elicit a change in some traits, while the expression of other traits disappeared within a week. Our results are consistent with those expected from phenotypic resonance. Expression of antipredator traits may be masked if individuals are not exposed to certain conditions at key ontogenetic stages.

Organisms often undergo shifts in habitats as their requirements change with ontogeny.Upon entering a new environment, it is vitally important to be able to rapidly assess predation risk. Predation pressure should selectively promote mechanisms that enable the rapid identification of novel predators. Here we tested the ability of a juvenile marine fish to simultaneously learn the identity of multiple previously unknown predators. Individuals were conditioned with a 'cocktail' of novel odours (from two predators and two non-predators) paired with either a conspecific alarm cue or a saltwater control and then tested for recognition of the four odours individually and two novel odours (one predator and one non-predator) the following day. Individuals conditioned with the 'cocktail' and alarm cue responded to the individual 'cocktail' odours with an antipredator response compared to controls. These results demonstrate that individuals acquire recognition of novel odours and that the responses were not due to innate recognition of predators or due to a generalised response to novel odours. Upon entering an unfamiliar environment prey species are able to rapidly assess the risk of predation, enhancing their chances of survival, through the assessment of chemical stimuli.

Doc number: 40 Abstract Background: Insomnia is common in primary care, can persist after co-morbid conditions are treated, and may require long-term medication treatment. A potential alternative to medications is cognitive behavioral therapy for insomnia (CBT-I). Methods: In accordance with PRISMA guidelines, we systematically reviewed MEDLINE, EMBASE, the Cochrane Central Register, and PsycINFO for randomized controlled trials (RCTs) comparing CBT-I to any prescription or non-prescription medication in patients with primary or comorbid insomnia. Trials had to report quantitative sleep outcomes (e.g. sleep latency) in order to be included in the analysis. Extracted results included quantitative sleep outcomes, as well as psychological outcomes and adverse effects when available. Evidence base quality was assessed using GRADE. Results: Five studies met criteria for analysis. Low to moderate grade evidence suggests CBT-I has superior effectiveness to benzodiazepine and non-benzodiazepine drugs in the long term, while very low grade evidence suggests benzodiazepines are more effective in the short term. Very low grade evidence supports use of CBT-I to improve psychological outcomes. Conclusions: CBT-I is effective for treating insomnia when compared with medications, and its effects may be more durable than medications. Primary care providers should consider CBT-I as a first-line treatment option for insomnia.

1. Learned predator recognition provides animals with an adaptive mechanism to rapidly adapt to current levels of predation risk. Prey may be able to reduce the cost associated with learning if they can use information learned about known predators to respond to cues from closely related predators with which they are unfamiliar. 2. The capacity of prey to generalize recognition and distinguish between novel predators and non-predators is poorly understood, particularly in species-diverse communities with many closely related predators and non-predators. 3. Lemon damselfish, Pomacentrus moluccensis, conditioned to recognize the odour of a predatory moon wrasse, Thalassoma lunare, as a risky stimulus, were subsequently tested for their response to T. lunare and a range of closely related predators and non-predators from within the Labridae family, a distantly related non-predator and a saltwater control. 4. Pomacentrus moluccensis displayed antipredator responses not only to T. lunare odour, but also generalized their recognition to congeneric T. amblycephalum and T. hardwicke odours. Recognition was not extended to other species within (Labridae; Coris batuensis and Halichoeres melanurus) or beyond (Pseudochromidae; Pseudochromis fuscus) the family. Individuals could not distinguish between the predator T. hardwicke and non-predator T. amblycephalum when generalizing their recognition to congeneric species based on chemosensory assessment alone. 5. Our results demonstrate that reef fishes may limit their generalization to congeneric species only, and may be unable to distinguish between predators and non-predators using chemosensory cues. Recognition patterns may result from uncertainties in predicting the identities of predators in species-diverse communities.

Predator–prey interactions are critical in ecological communities, but it is increasingly clear that a predator’s effect goes beyond eating prey. Fear of predators may also alter the behaviour, physiology, and morphology of prey as they try to reduce risk. Such ‘non-consumptive effects’ (NCEs) may have important demographic effects on prey populations. The study of NCEs has recently grown significantly across marine ecosystems, including coral reefs. Coral reefs support diverse predator assemblages, and consumptive effects substantially impact prey populations, suggesting NCEs are also likely to be important. Indeed, a growing number of aquarium and field studies have demonstrated that the behaviour of reef fishes is changed by predators, typically using predator models or a gradient of fishing pressure. Here, we review these studies to summarise what is currently known about NCEs in reef-fish assemblages, including effects on individuals and populations and variations in space and time caused by predator and prey traits and environmental factors, and the evidence for NCEs driving trophic cascades. Critically, throughout we also draw on a wider literature to highlight hypotheses and theories emerging in other ecosystems that can inform further work on reefs. While it is clear NCEs are significant among reef fishes and can alter reef functioning, evidence of demographic changes, mechanistic pathways (e.g. behavioural vs. stress induced), and work with multiple predators and prey is lacking. We suggest that establishing an initial framework of interactions among different predator and prey types is needed, allowing the integration of factors such as habitat complexity and internal prey state (e.g. hunger), and an increased understanding of how fishes move around seascapes of fear and how to integrate NCEs into ecosystem models. Such integration is critical for a fuller understanding of how fish assemblages function, interact with benthic organisms, and will be affected by environmental stressors.

A half century after he developed it, Gordon Tullock’s idea of rent seeking is more relevant than ever. Though the concept has gained widespread acceptance among academics, it has yet to make an impression on public discourse. But with favoritism, corruption, and the power of special interests in the headlines, the idea deserves broader attention. In this special issue of Public Choice we commemorate Tullock’s insight. Contributors examine the making of this classic piece and its effect on economic theory, empirical analysis, and economic teaching. Original papers also develop new insights into questions of development, the control of violence, corruption, culture, equity, regulation, rent extraction, the Political Coase Theorem, and more.

One might obtain special favor or avoid disfavor by winning a competitive contest, a socially wasteful process that has been studied extensively in the rent-seeking literature. But favor or disfavor might also be uncontestable. In that case it will be efficient along some dimensions but grossly inequitable. The rent-seeking literature, in focusing on contest success functions, has tended to ignore the institutional roots of uncontestable rentcreation and rent-extraction. But casual observation suggests that institutional rules and cultural norms often ensure that favor and disfavor cannot be easily contested. Understanding that observation helps to resolve the Tullock paradox and explains the evolutionary persistence of inequitable social arrangements. It also illuminates economic and philosophical tradeoffs.