Recently implemented Chinese health insurance schemes have failed to achieve a Chinese health care system that is family-oriented, family-based, family-friendly, or even financially sustainable. With this diagnosis in hand, the authors argue that a financially and morally sustainable Chinese health care system should have as its core family health savings accounts supplemented by appropriate health insurance plans. This essay’s arguments are set in the context of Confucian moral commitments that still shape the background culture of contemporary China.

Background: Although ethics consultation has been introduced to clinical practice for many years, the results of empirical studies to evaluate the effectiveness of ethics consultation are still controversial. The design of randomised controlled trials is considered the best research design to evaluate the effect of a clinical practice on the outcomes of interests. In order to understand the effects of ethics consultation, we conducted this search for studies with the design of randomised controlled trials to evaluate ethics consultation.Objective: To provide (...) an integrated review of studies with the design of randomised controlled trials to evaluate the effectiveness of ethics consultation.Methods: PubMed was used to search for studies using the randomised controlled trial design to evaluate the effectiveness of ethics consultation. The search term used was “ethics consultation”. The selection criterion was limited to “randomised controlled trial”.Results: Four articles that met both search criteria were retrieved. One of these articles reported a study that did not actually use the design of a randomised controlled trial and is excluded from the following discussion.Conclusions: To apply randomised controlled trials to evaluate the effectiveness of ethics consultation is extremely difficult as long as two issues are not resolved: the standardisation of ethics consultation and a placebo for ethics consultation to eliminate the placebo effect. Thus, the results generated by the design of randomised controlled trials are always problematic. Furthermore, as long as the two issues exist, the results generated by the design of quantitative research methods always pose problems. (shrink)

The apolipoprotein E gene plays an important role in the pathogenesis of Alzheimer's disease , and amyloid plaque comprised mostly of the amyloid-beta peptide ) is one of the major hallmarks of AD. However, the relationship between these two important molecules is poorly understood. We examined how A treatment affects APOE expression in cultured cells and tested the role of the transcription factor NF-B in APOE gene regulation. To delineate NF-B's role, we have characterized a 1098 nucleotide segment containing the (...) 5'-flanking region of the human APOE gene . Sequence analysis of this region suggests the presence of two potential NF-B elements. To demonstrate promoter activity, the region was cloned upstream of a promoterless luciferase gene. This segment was able to drive expression of luciferase in transient transfections of human fetal glial cells. Promoter activity was stimulated twofold by A treatment. Pretreatment with double-stranded DNA decoy oligonucleotides against NF-B reduced A stimulation. Deletion and mutagenetic analyses demonstrated that the distal NF-B element was functional and showed a strong DNA-protein complex band in gel shift analysis, similar to that from control NF-B consensus element. An anti-inflammatory and anti-NF-B drug, sodium salicylate, significantly blocked A-induced APOE promoter function. Our data provide evidence that upregulation of APOE by A in astroglial cells is mediated by an NF-B-element present in the 5'-flanking region of the APOE gene. (shrink)

Objectives: To investigate the current situation of completing the informed consent for do-not-resuscitate (DNR) orders among the competent patients with terminal illness and the ethical dilemmas related to it. Participants: This study enrolled 152 competent patients with terminal cancer, who were involved in the initial consultations for hospice care. Analysis: Comparisons of means, analyses of variance, Student’s t test, χ2 test and multiple logistic regression models. Results: After the consultations, 117 (77.0%) of the 152 patients provided informed consent for hospice (...) care and DNR orders. These included 21 patients (17.9%) who signed the consent by themselves, and 96 (82.1%) whose consent sheet was signed only by family members. The reasons why patients were not involved in the discussions toward the consent (n = 82) included poor physical or psychological condition (44.9%), concerns of the consultant hospice team (37.2%), and the family’s refusal (28.2%). On a multivariate analysis, patients’ awareness of their poor prognosis (odds ratio = 4.07, 95% confidence interval = 2.05 to 8.07) and their understanding of hospice care (2.27, 1.33 to 3.89) were two independent factors (p<0.01) that influenced their participation in the discussions or their personal signature in the informed consent. Conclusion: The family-oriented culture in Asian countries may violate the principles of the Patient Self-Determination Act and the requirements of the Hospice Care Law in Taiwan, which inevitably poses an ethical dilemma. Earlier truth-telling and continuing education of the public by hospice care workers will be helpful in solving such ethical dilemmas. (shrink)

Behaving ethically depends on the ability to recognize that ethical issues exist, to see from an ethical point of view. This ability to see and respond ethically may be related more to attributes of corporate culture than to attributes of individual employees. Efforts to increase ethical standards and decrease pressure to behave unethically should therefore concentrate on the organization and its culture. The purpose of this paper is to discuss how total quality (TQ) techniques can facilitate the development of a (...) cooperative corporate culture that promotes and encourages ethical behavior throughout an organization. (shrink)

ABSTRACTDespite interest in exercise as a treatment for anxiety disorders the mechanism behind the anxiolytic effects of exercise is unclear. Two observations motivate the present work. First, engagement of attention control during increased working memory load can decrease anxiety. Second, exercise can improve attention control. Therefore, exercise could boost the anxiolytic effects of increased WM load via its strengthening of attention control. Anxiety was induced by threat of shock and was quantified with anxiety-potentiated startle. Thirty-five healthy volunteers participated in two (...) types of activity, exercise and control-activity. After each activity, participants completed a WM task at low- and high-load during safe and threat. Results were not consistent with the hypothesis: exercise vs. control-activity increased APS in high-load. However, this incre... (shrink)

Venneman and colleagues argue that “do not resuscitate” (DNR) is problematic and should be replaced by “allow natural death” (AND). Their argument is flawed. First, while end-of-life discussions should be as positive as possible, they cannot and should not sidestep painful but necessary confrontations with morality. Second, while DNR can indeed be nonspecific and confusing, AND merely replaces one problematic term with another. Finally, the study’s results are not generalisable to the populations of physicians and working nurses and certainly do (...) not support the authors’ claim that there is a movement to replace DNR with AND. (shrink)

In _Animacies_, Mel Y. Chen draws on recent debates about sexuality, race, and affect to examine how matter that is considered insensate, immobile, or deathly animates cultural lives. Toward that end, Chen investigates the blurry division between the living and the dead, or that which is beyond the human or animal. Within the field of linguistics, animacy has been described variously as a quality of agency, awareness, mobility, sentience, or liveness. Chen turns to cognitive linguistics to stress (...) how language habitually differentiates the animate and the inanimate. Expanding this construct, Chen argues that animacy undergirds much that is pressing and indeed volatile in contemporary culture, from animal rights debates to biosecurity concerns. Chen's book is the first to bring the concept of animacy together with queer of color scholarship, critical animal studies, and disability theory. Through analyses of dehumanizing insults, the meanings of queerness, animal protagonists in recent Asian/American art and film, the lead in toys panic in 2007, and the social lives of environmental illness, _Animacies_ illuminates a hierarchical politics infused by race, sexuality, and ability. In this groundbreaking book, Chen rethinks the criteria governing agency and receptivity, health and toxicity, productivity and stillness—and demonstrates how attention to the affective charge of matter challenges commonsense orderings of the world. (shrink)

The problem of race has typically been treated as a problem of individual or institutional prejudice. However, more attention needs to be paid to structural racism, which shows how racialized opportunity structures sustain racial injustice even when actors are not prejudiced. Because Catholic social thought treats social structures as mere aggregates of individual behavior, however, it is unable to explain how opportunity structures constrain human agency, how social positions condition the behaviors of people who occupy them, and how harms may (...) occur without intent. A critical realist approach to understanding social structure corrects the reductive tendencies of dominant perspectives on race, such as colorblindness and antiracism, and helps explain how nonracists can perpetuate racial injustice. An analysis of the case of residential segregation shows how the pursuit of individual goods in racialized opportunity structures like the housing market simultaneously hinders the common good. (shrink)

The human capacity for intersubjective engagement is present, even when one is limited in speaking, pointing, and coordinating gaze. This paper examines the everyday social interactions of two differently-disposed actors—a non-speaking autistic child and his speaking, neurotypical mother—who participate in shared attention through dialogic turn-taking. In the collaborative pursuit of activities, the participants coordinate across multiple turns, producing multi-turn constructions that accomplish specific goals. The paper asks two questions about these collaborative constructions: 1) What are their linguistic and discursive structures? (...) 2) How do embodied actions contribute to these constructions? Findings show that the parent and child repeatedly co-produced multi-turn constructions that had consistent structures, implying a sophisticated ability to anticipate the completion of action trajectories. Examining the embodied actions of interactants revealed that the child often accommodated to the parent’s demands for participation. Nonetheless, the child occasionally pursued his own goals by improvising with and within multi-turn constructions. He launched constructions to redirect parental attention, and otherwise produced surprising actions within the turn-taking structure of these constructions. The paper concludes that multi-turn constructions in the midst of activities are a primordial site in which to begin observing the competencies of non-speaking autistic children for intersubjective engagement. (shrink)

What is the future of Philosophy of education? Or as many of scholars and thinkers in this final ‘future-focused’ collective piece from the philosophy of education in a new key Series put it, what are the futures—plural and multiple—of the intersections of ‘philosophy’ and ‘education?’ What is ‘Philosophy’; and what is ‘Education’, and what role may ‘enquiry’ play? Is the future of education and philosophy embracing—or at least taking seriously—and thinking with Indigenous ethicoontoepistemologies? And, perhaps most importantly, what is that (...) ‘Future’? These debates have been located in the work of diverse scholars: from the West, from Global South, from indigenous thinkers. In this collective piece, we purposefully juxtapose diverse takes on the future of these intersections. We have given up the urge to organise, place together, separate with subheadings or connect the paragraphs that follow. Instead, we let these philosophers of education and thinkers who use philosophical texts and ideas to sit together in one long read as potentially ‘strange and unusual bedfellows’. This text urges us to understand how these scholars and thinkers perceive our educational philosophical futures, and how the work and thinking they have done on thinking about what the future of that new key in philosophy of education may look like is embedded in a much deeper and richer literature, and personal experience. (shrink)

Drawing on the behavioral theory, this study examines how the misalignment between a firm's environmental effort and the level of subsidies received from the government in affecting the firm's investment in non-environmental R&D. Based on a sample of Chinese A-share listed firms from 2008 to 2019 and using polynomial regression techniques, our findings reveal that firms in the “low effort-high subsidies” group exhibit lower non-environmental R&D intensity compared to firms in the “high effort-low subsidies” group. This study contributes to the (...) literature by shedding light on the interplay between corporate environmental efforts, government subsidies, and non-environmental R&D investment. The findings suggest the importance of aligning the environmental efforts of firms with subsidy levels from the government to effectively allocate resources for different types of R&D. The implications of this research suggest that firms should carefully consider aligning their environmental efforts with government subsidies to optimize their investment in non-environmental R&D and overall innovation strategy. Furthermore, the study indicates that firms and governments should prudently balance the relationship between environmental R&D and non-environmental R&D to avoid any negative impact on the latter. (shrink)

Five experiments investigated how people use categories to make inductions about objects whose categorisation is uncertain. Normatively, they should consider all the categories the object might be in and use a weighted combination of information from all the categories: bet-hedging. The experiments presented people with simple, artificial categories and asked them to make an induction about a new object that was most likely in one category but possibly in another. The results showed that the majority of people focused on the (...) most likely category in making inductions, although there was a group of consistently normative responders who used information from both categories (about 25% of our college population). Across experiments the overall pattern of results suggests that performance in the task is improved not by understanding the underlying principles of bet-hedging but by increasing the likelihood that multiple categories are in working memory at the time of the induction. We discuss implications for improving everyday inductions. (shrink)

There is currently an evidentiary gap in the scholarship concerning medical tourism's impact on low- and middle-income destination countries (LMICs). This article reviews relevant evidence that exists and concludes that there are signs of correlation between medical tourism and the expansion of private, technology- intensive health care in LMICs, which has largely remained out of reach for the majority of the local patients. In light of this health care inequity between local residents and medical tourists in LMICs, we argue that (...) the presumption should not be in favor of medical tourism and that governments have a legitimate interest in seeking to regulate this industry to ensure that the net effects for their citizens is positive. Moreover, sending countries, particularly those in the developed world, have the responsibility to adopt public policies to diminish demand on the part of their citizens for medical tourism and to work with LMICs to ensure that the growth of medical tourism does not occur at the expense of the poorest of the poor. (shrink)

Increasing gender diversity in the boardroom has been promoted as a way to enhance corporate governance and risk management. This study empirically examines whether boards with more female directors play a role in reducing R&D risk. We first show that female directors help to reduce the positive relationship between R&D investment and future performance volatility. We then report that firms with more gender-diverse boards exhibit a lower adverse effect of R&D on the cost of debt. These results are robust to (...) endogeneity analysis, alternative measures of gender diversity and risky investment, and other sensitivity tests. Overall, our results suggest that female directors improve board effectiveness in risk management with respect to R&D investment. (shrink)

In Everettian quantum mechanics, justifications for the Born rule appeal to self-locating uncertainty or decision theory. Such justifications have focused exclusively on a pure-state Everettian multiverse, represented by a wave function. Recent works in quantum foundations suggest that it is viable to consider a mixed-state Everettian multiverse, represented by a (mixed-state) density matrix. Here, we develop the conceptual foundations for decoherence and branching in a mixed-state multiverse, and extend the standard Everettian justifications for the Born rule to this setting. This (...) extended framework provides a unification of 'classical' and 'quantum' probabilities, and additional theoretical benefits, for the Everettian picture. (shrink)

The radical nub of Byrne & Russon's argument is that passive priming effects can produce much of the evidence of higher-order cognition in nonhuman primates. In support of their position we review evidence of similar behavioral priming effects n humans. However, that evidence further suggests that even program-level imitative behavior can be produced through priming.

We introduce a notion of pseudo-reachability in Gaifman graphs and suggest a graph-theoretic and uniform approach to the Löwenheim-Skolem-Tarski Theorems for partition logics as well as logics with general Malitz quantifiers.

Arbuscular mycorrhizal fungi are considered as a potential biotechnological tool for improving phytostabilization efficiency and plant tolerance to heavy metal-contaminated soils. However, the mechanisms through which AMF help to alleviate metal toxicity in plants are still poorly understood. A greenhouse experiment was conducted to evaluate the effects of two AMF species on the growth, Pb accumulation, photosynthesis and antioxidant enzyme activities of a leguminous tree at Pb addition levels of 0, 500, 1000 and 2000 mg kg-1 soil. AMF symbiosis decreased (...) Pb concentrations in the leaves and promoted the accumulation of biomass as well as photosynthetic pigment contents. Mycorrhizal plants had higher gas exchange capacity, non-photochemistry efficiency, and photochemistry efficiency compared with non-mycorrhizal plants. The enzymatic activities of superoxide dismutase, ascorbate peroxidases and glutathione peroxidase were enhanced, and hydrogen peroxide and malondialdehyde contents were reduced in mycorrhizal plants. These findings suggested that AMF symbiosis could protect plants by alleviating cellular oxidative damage in response to Pb stress. Furthermore, mycorrhizal dependency on plants increased with increasing Pb stress levels, indicating that AMF inoculation likely played a more important role in plant Pb tolerance in heavily contaminated soils. Overall, both F. mosseae and R. intraradices were able to maintain efficient symbiosis with R. pseudoacacia in Pb polluted soils. AMF symbiosis can improve photosynthesis and reactive oxygen species scavenging capabilities and decrease Pb concentrations in leaves to alleviate Pb toxicity in R. pseudoacacia. Our results suggest that the application of the two AMF species associated with R. pseudoacacia could be a promising strategy for enhancing the phytostabilization efficiency of Pb contaminated soils. (shrink)

This study investigates the impact of labor unionization on stock price crash risk. We find that labor unionization is negatively associated with stock price crash risk. Such negative relation is more pronounced when firms can intimate more credible evidence on unfavorable prospects and when firms face more powerful labor unions. Our findings are consistent with the notion that firms take strategic actions to reduce the bargaining advantages enjoyed by labor unions and that labor unions force firms to take less risky (...) investments and discontinue underperformed projects more timely, which leads to lower stock price crash risk. (shrink)

This paper is an experiment in Leibnizian analysis. The reader will recall that Leibniz considered all true sentences to be analytically so. The difference, on his account, between necessary and contingent truths is that sentences reporting the former are finitely analytic; those reporting the latter require infinite analysis of which God alone is capable. On such a view at least two competing conceptions of entailment emerge. According to one, a sentence entails another when the set of atomic requirements for the (...) first is included in the corresponding set for the other; according to the other conception, every atomic requirement of the entailed sentence is underwritten by an atomic constituent of the entailing one. The former conception is classical on the twentieth century understanding of the term; the latter is the one we explore here. Now if we restrict ourselves to the formal language of the propositional calculus, every sentence has a finite analysis into its conjunctive normal form. Semantically, then, every sentence of that language can be represented as a simple hypergraph, H, on the powerset of a universe of states. Entailment of the sort we wish to study can be represented as a known relation, subsumption between hypergraphs. Since the lattice of hypergraphs thus ordered is a DeMorgan lattice, the logic of entailment thus understood is the familiar system, FDE of first-degree entailment. We observe that, extensionalized, the relation of subsumption is itself a DeMorgan Lattice ordered by higher-order subsumption. Thus the semantic idiom that hypergraph-theory affords reveals a hierarchy of lattices capable of representing entailments of every finite degree. (shrink)

Travelling internationally to acquire medical treatments otherwise unavailable or inaccessible in one’s home country is not a novel concept. Conventionally, such medical travel largely entailed patients from developed countries or wealthy patients from the developing world seeking care in Western facilities like the Mayo Clinic in the U.S. and myriad private clinics along Harley Street in London, England. What is different about the topical phenomenon known as “medical tourism” is the growing trend of health services export in the opposite direction. (...) The number of patients travelling from the developed world to low- and middle-income countries for treatments has ballooned in recent years, primarily driven by difficulties with accessing affordable care at home. According to a liberal estimate by the Deloitte Center for Health Solutions, the number of Americans travelling abroad for care rose from 750,000 in 2007 to 1.6 million in 2012. On the flip side, Thailand reportedly treated a total of 1.3 million foreign nationals in 2007, which represented a 16% leap from 2001. (shrink)