This series of articles by Charles Dougherty, Robert Berenson, and Kathleen Powderly and Elaine Smith, as well as “Cost Containment: Challenging Fidelity and Justice” by E. Haavi Morreim (Hastings Center Report, December 1988), result from a Hastings Center project, “Ethics and Prospective Payment Systems: DRGs.” The two-year project was jointly funded by The General Electric Foundation and the American Medical Association Education and Research Foundation.The project tried to gauge the systematic effects of the introduction of cost containment (...) class='Hi'>strategies, prospective payment by Diagnostic Related Groups in particular, on the provision of health care and the ethical practice of medicine. Cost containment strategies, no matter how necessary in curbing spiraling medical costs, leave no sector or participants in the health care system untouched—hospitals and other health care institutions; doctors, nurses, social workers and other health care professionals; patients, their families, and the thirty-six to forty million medically indigent. The articles discuss the several and interrelated ethical issues raised by the DRG prospective payment system (Dougherty); its particular affect on the doctor-patient relationship and how it is transforming the ethical practice of medicine (Berenson and Morreim); and its specific impact on the professions and professional ethics of nursing and social work (Powderly and Smith). The overall message of the articles is that the health professions, their provision of care, and the ethics of their practices—as driven by economic considerations and realities—are in the midst of a more or less radical sea change. (shrink)

Companies disclosing negative aspects in sustainability reports often employ legitimation strategies to present mishaps in a favorable light. In incentivized experiments, we find that nonprofessional investors divest from companies with a negative sustainability-related incident, and that symbolic legitimation (which only evasively explains a negative incident) is not a strong enough signal to counter this divestment behavior. Even substantial legitimation (which reports on measures and behavioral change) mitigates the divestment decisions only if the company reports on concrete remediation actions (...) in morally charged situations, such as social or environmental incidents. We elaborate these results in light of signaling and screening theory, and suggest the conceptual extension of “costly signals” to what we call “valuable signals.” We argue that valuable signals need be not only costly for the sender from an economic perspective but also perceived as appropriate by the receiver from a noneconomic perspective. (shrink)

In this article, we apply the UN Guiding Principles on Business and Human Rights to the private equity (PE) business model. PE firms often adopt a controversial, ‘value extractive’, business model based on high debt and extreme cost-cutting to generate investor returns. PE firms own large numbers of companies, including in many rights-related sectors. The model is linked to increased human rights risks to workers, housing tenants, and in privatized health and social care. We map these risks and (...) analyse the human rights responsibilities of PE firms. Our analysis has major implications for understandings of human rights responsibility. We argue that value extractive methods are the root cause of eventual harm to human rights, even though they may not harm rights directly. To respect human rights, PE firms must mitigate the risks of these value extractive methods. We define how human rights due diligence (HRDD) could achieve this and argue that given the extent of harm and the lack of a business case for adopting such a view of human rights responsibility, business strategy level HRDD should be a core component of forthcoming HRDD laws. (shrink)

Improving the reliability of electricity supply is closely related to the national industrial economy and people’s livelihood. When procuring electricity, the large consumer faces the risk of insufficient electricity supply. Such insufficiency may be caused by the supply disruption of the upstream electricity generator and the fluctuation of electricity prices in the electricity pool. We establish an expected cost model for the large consumer and a revenue model for the electricity generator by introducing robustness and opportunity functions to (...) analyse the impact of supply disruption and price fluctuation on both members. Then, we obtain the optimal reliability level and subsidy rate. Our analytical results reveal the following points: During an electricity price fluctuation, the sufficient and necessary condition for the large consumer to expect high robustness of his own decision-making is to pay a high cost. The high uncertainty of electricity price leads to less revenue for the electricity generator; thus, the electricity generator should perform well in price forecasting. Without disruption risk, the electricity generator is reliable. Furthermore, the electricity pool is unreliable from the perspective of price. However, the electricity supply of the electricity generator is no longer reliable when considering disruption risk, whereas the electricity pool is reliable because the large consumer is tolerant of price fluctuation under this circumstance. Moreover, the impacts of market uncertainty and players’ attributes on the optimal strategies are explored. (shrink)

The emergence of conflicts between environmental safety incidents and protection rights generates sizeable political costs, which endangers the legitimacy of the government as well as political security and stability. This article further examines the role of political costs in environmental issues. First, political costs in relation to environmental issues are defined. An equilibrium strategic analysis is then presented using an evolutionary game model in which the strategic behavioral choices of government, enterprises, and citizens are investigated by embedding political costs in (...) the environmental governance system. Furthermore, the small-signal model was innovatively applied to simulate and analyze the stability of political costs under different equilibrium strategies in the system. The results show the following. Pubic behavior and government are the dominant factors that impact stability and instability, respectively. Public behavior is the core element that affects political cost consumption. When political costs are extremely depleted, the public will neglect economic interests, turn toward environmental interests, and choose the negative participation strategy, which destabilizes the system. The political cost signal at the optimal equilibrium point not only warns the government not to take the desperate action of concealing information asymmetry but also allows the government to let go of its hands to deal with the environmental issues. Corresponding policy recommendations are proposed. (shrink)

We seek insights into potential benefits for firms adopting strategies to improve business sustainability in a carbon-constrained future. We investigate whether lenders incorporate a firm’s exposure to carbon-related risk into lending decisions through the cost of financing, and if so, importantly whether firms can mitigate the penalty by demonstrating an awareness of their carbon risks. We use a sample of 255 firm-year observations from eight industries over the period 2009–2013. We measure carbon-related risk exposure as the (...) firm’s historical carbon emissions and our primary measure of carbon risk awareness is based on the firm’s willingness to respond to the Carbon Disclosure Project survey. We document a positive association between cost of debt and carbon risk for firms failing to respond to the CDP. Further, this association is economically meaningful, with a one standard deviation increase in carbon risk mapping into between a 38 and 62 basis point increase in the cost of debt. Equally, we find that this penalty is effectively negated for firms exhibiting carbon risk awareness. Our results are robust when we consider alternate measures of carbon awareness—disclosure through alternative medium to the CDP and firms’ annual cash investment in new capital assets using “cleaner” technology. Our results highlight not only the importance of carbon awareness as a business strategy for polluting firms, but also its importance to lenders exposed to their clients’ default and reputational risk. The debt market appears to incorporate historical carbon emissions and forward-looking indicators of carbon performance. (shrink)

Reproduction, a basic property of biological life, entails costs for an organism, ultimately detectable as reduction in survival prospects. Telomeres are an excellent candidate biomarker for explaining these reproductive costs, because their shortening correlates with increased mortality risk. For similar reasons, telomeres are perceived as biomarkers of individual “quality.” The relationship between reproduction and telomere dynamics is reviewed, emphasizing that cost and quality perspectives, commonly presented in isolation, should be integrated. While a majority of correlative studies have confirmed the (...) relationship between telomere dynamics and various reproductive outputs, only limited experimental support exists showing that reproduction causes telomeres to shorten. A shift of focus to experimental manipulations of reproductive effort/telomere dynamics is crucial. However, the observation of survival reduction in response to these manipulations is essential for establishing telomeres as genuine biomarkers, allowing to unravel trade‐offs related to reproduction. (shrink)

The objective of Working Group 4 of the COST Action NET4Age-Friendly is to examine existing policies, advocacy, and funding opportunities and to build up relations with policy makers and funding organisations. Also, to synthesize and improve existing knowledge and models to develop from effective business and evaluation models, as well as to guarantee quality and education, proper dissemination and ensure the future of the Action. The Working Group further aims to enable capacity building to improve interdisciplinary participation, to promote (...) knowledge exchange and to foster a cross-European interdisciplinary research capacity, to improve cooperation and co-creation with cross-sectors stakeholders and to introduce and educate students SHAFE implementation and sustainability. To enable the achievement of the objectives of Working Group 4, the Leader of the Working Group, the Chair and Vice-Chair, in close cooperation with the Science Communication Coordinator, developed a template to map the current state of SHAFE policies, funding opportunities and networking in the COST member countries of the Action. On invitation, the Working Group lead received contributions from 37 countries, in a total of 85 Action members. The contributions provide an overview of the diversity of SHAFE policies and opportunities in Europe and beyond. These were not edited or revised and are a result of the main areas of expertise and knowledge of the contributors; thus, gaps in areas or content are possible and these shall be further explored in the following works and reports of this WG. But this preliminary mapping is of huge importance to proceed with the WG activities. In the following chapters, an introduction on the need of SHAFE policies is presented, followed by a summary of the main approaches to be pursued for the next period of work. The deliverable finishes with the opportunities of capacity building, networking and funding that will be relevant to undertake within the frame of Working Group 4 and the total COST Action. The total of country contributions is presented in the annex of this deliverable. (shrink)

This study presented the policy of functional integration of the product planning team as a strategy for the development of the pharmaceutical industry in Palestine. The study population consists of all the workers in companies operating in the field of medicine in Palestine, which are (5) companies producing in the West Bank only for pharmaceuticals used by these companies, which are (296) employees, and was used a simple random sample to choose the sample and size (87) employees of the study (...) population, and to achieve the objectives of the study (87) questionnaires were distributed. The descriptive analytical method was used, and SPSS was used to answer and discuss the study's questions. The results showed that there is a significant relationship between the effectiveness of the policy of product development and the competitiveness of pharmaceutical companies in Palestine (West Bank), where the policy of product development efficiency accounts for 56.6% of the total change in the competitiveness of companies. The product quality component was most influential at all levels of product development effectiveness policy, followed by product identification, product cost reduction, packaging and product deletion. The weakest areas of strategic direction in pharmaceutical companies in Palestine (West Bank) are 67%. The weakest aspects of job integration are: non-regular meetings of representatives of different positions to participate in any project related to product development, to achieve spatial convergence of members of the product planning policy team in offices, laboratories and workplaces. (shrink)

On the basis of an interdisciplinary approach linking taxation, marketing, and corporate social responsibility, the present research investigates the effects of media reports on aggressive and responsible corporate tax strategies (CTSs) on corporate success with consumers. By means of two laboratory experiments (N = 150, 360), we analyze the effects of the CTSs on corporate reputation, consumer purchase intention, and the consumer’s willingness to pay. Our results suggest that aggressive CTSs diminish corporate success with consumers, whereas responsible CTSs enhance (...) it. Nevertheless, consumers are not willing to pay a price premium for products sold by responsible tax-planning companies, but rather punish aggressive tax-planning companies through a slightly lower willingness to pay. Finally, consumers’ tax morale and their attitude toward tax avoidance are important moderating variables. Given the growing level of media interest in taxation, our findings are crucial for assessing consumer-related non-tax costs and the benefits of different CTSs. (shrink)

BackgroundMedical errors, unsatisfactory outcomes, or treatment complications often prompt patient complaints about healthcare providers. In response, physicians may adopt defensive practices to mitigate objections, avoid complaints, and navigate lengthy trial processes or other potential threats. However, such defensive medicine (DM) practices can carry risks, including potential harm to patients and the imposition of unnecessary costs on both patients and the healthcare system. Moreover, these practices may run counter to accepted ethical standards in medicine.MethodsThis qualitative study involved conducting semi-structured interviews with (...) 43 physicians, among whom 38 were faculty members at medical universities, 42 had administrative experience at various levels of the health system, and 23 had previously served as health system policymakers. On average, the participants had approximately 23.5 years of clinical experience. The selection of participants was based on purposive sampling. Data collection through interviews continued until data saturation was achieved.ResultsBased on the findings, DM manifests in both positive and negative forms, illustrated by instances like ordering unnecessary lab tests, imaging, or consultations, reluctance to admit high-risk patients, and avoiding high-risk procedures. The study participants identified a range of underlying and contextual factors contributing to DM, encompassing organizational-managerial, social, personal, and factors inherent to the nature of defensive medical practices. The results also highlight proposed strategies to address and prevent DM, which can be grouped into organizational-managerial, social, and those focused on modifying the medical complaints management system.ConclusionDM is a multifaceted and significant phenomenon that necessitates a comprehensive understanding of its various aspects, including interconnected and complex structures and underlying and contextual factors. While the results of this study offer a solid foundation for informing policy decisions within the healthcare system and include some explanatory policy suggestions, we encourage policymakers to complement the findings of this study with other available evidence to address any potential limitations and to gain a more comprehensive understanding of the policymaking process related to DM. (shrink)

Scholars have studied the various pressures that companies face related to socially responsible behavior when stakeholders know the particular social issues under consideration. Many have examined social responsibility in the context of environmental responsibility and the general approaches companies take regarding environmental management. The issue of currently unregulated, but potentially hazardous, chemicals in consumer products is not well understood by the general public, but a number of proactive consumer product companies have voluntarily adopted strategies to minimize use of (...) such chemicals. These companies are exceeding regulatory requirements by restricting from their products chemicals that could harm human or environmental health, despite the fact that these actions are costly. They do not usually advertise the details of their strategies to end consumers. This article uses interviews with senior environmental directors of 20 multinational consumer product companies to investigate why these companies engage in voluntary chemicals management. The authors conclude that the most significant reasons are to achieve a competitive advantage and stay ahead of regulations, manage relationships and maintain legitimacy with stakeholders, and put managerial values into practice. Many of the characteristics related to the case of chemicals management are extendable to other areas of stakeholder management in which risks to stakeholders are either unknown or poorly understood. (shrink)

BackgroundPrecision medicine development is driven by the possibilities of next generation sequencing, information technology and artificial intelligence and thus, raises a number of ethical questions. Empirical studies have investigated such issues from the perspectives of health care professionals, researchers and patients. We synthesize the results from these studies in this review.MethodsWe used a systematic strategy to search, screen and assess the literature for eligibility related to our research question. The initial search for empirical studies in five data bases provided (...) 665 different records and we selected 92 of these publications for inclusion in this review. Data were extracted in a spreadsheet and categorized into different topics representing the views on ethical issues in precision medicine.ResultsMany patients and professionals expect high benefits from precision medicine and have a positive attitude towards it. However, patients and professionals also perceive some risks. Commonly perceived risks include: lack of evidence for accuracy of tests and efficacy of treatments; limited knowledge of patients, which makes informed consent more difficult; possible unavailability of access to precision medicine for underprivileged people and ethnic minorities; misuse of data by insurance companies and employers, potential of racial stigmatization due to genetic information; unwanted communication of incidental findings; changes in doctor-patient-relationship through focusing on data; and the problem that patients could feel under pressure to optimize their health.ConclusionsNational legislation and guidelines already minimize many risks associated with precision medicine. However, from our perspective some problems require more attention. Should hopes for precision medicine’s benefits be fulfilled, then the ethical principle of justice would require an unlimited access to precision medicine for all people. The potential for autonomous patients’ decisions must be greatly enhanced by improvements in patient education. Harm from test results must be avoided in any case by the highest possible data security level and communication guidelines. Changes in the doctor-patient relationship and the impact of precision medicine on the quality of life should be further investigated. Additionally, the cost-effectiveness of precision medicine should be further examined, in order to avoid malinvestment. (shrink)

Health information technology in hospitals can be approached as a tool to reduce health care costs and improve hospital efficiency and profitability, increase the quality of healthcare services, and make the transition to patient-centered healthcare. A hospital’s efficiency and profitability depends on linking IT with the knowledge and motivation of medical personnel. It is important to design and execute a knowledge management strategy as a part of the implementation of IT in hospital management. A Diagnosis-Related Groups system was introduced (...) in Poland in 2008 as a basis for settlements between hospitals and the National Health Fund. The importance and role of a DRG system in management of healthcare entities was emphasized based on a survey of medical professionals from two hospitals in the Lubelskie province. The goal of a survey is to assess the knowledge of medical professionals about the DRG system and how the medical personnel uses the DRG system in order to achieve the strategic goals of the organization. A newly developed survey was used to assess the medical personnel’s knowledge of DRG, using 12 closed and 5 open questions. The survey was conducted on 160 medical employees from two hospitals in the Lubelskie province. In conclusion, medical personnel’s DRG knowledge unambiguously contributes to reducing hospital costs and increasing profitability. The DRG related knowledge enables personnel to obtain value from data by applying DRG data-driven decisions. (shrink)

Mounting evidence documents the extraordinary toll on human health resulting from the consumption of unhealthy food products and physical inactivity. Diseases related to poor nutrition – such as diabetes, heart disease, stroke, and some cancers – are among the leading causes of disability and death in the United States. Poor diet and lack of exercise come second only to tobacco use in actual causes of preventable death in this country. It is estimated that 6% of all adult health care, (...) 7% of Medicare, and 11% of Medicaid expenditures are attributable to obesity. According to the Centers for Disease Control and Prevention, the direct medical cost associated with physical inactivity was nearly $76.6 billion in 2000.In response to America's growing obesity problem, local policymakers have been looking for legal strategies to adopt in their communities to encourage healthful behaviors. Taking the lead from the successful tobacco control movement, nutrition advocates are seeking strategies to “denormalize” unhealthy behaviors, rather than pursuing education-based approaches that encourage individuals to change their own personal behavior. (shrink)

The complexity of the physiological phenotype currently prevents us from identifying an integrative measure to assess how the internal state and environmental conditions modify life‐history strategies. In this article, it is proposed that shorter telomeres should lead to a faster pace‐of‐life where investment in self‐maintenance is decreased as a means of saving energy for reproduction, but at the cost of somatic durability. Inversely, longer telomeres would favor an increased investment in soma maintenance and thus a longer reproductive lifespan (...) (i.e., slower pace‐of‐life). Under this hypothesis, telomere dynamics could be such an integrative mediator, which will assemble the information about oxidative stress levels, inflammation status and stress reactivity, and relate this information to the potential lifespan of the organism and its pace‐of‐life strategy. The signaling function of telomere dynamics can also reach over generations, a phenomenon in which the telomere lengths of gametes would provide a channel through which offspring would receive information about their environment early in their development, hence increasing the possibilities for developmental plasticity. -/- . (shrink)

Research and practice of Voluntary Earnings Disclosure (VED) as a strategy are limited, notwithstanding its evidenced contribution to firm value. An emerging VED profile is identified, characterised and evaluated. Firms applying it regularly provide VED between quarterly earnings announcements. This profile is compared with the prevailing approach of issuing VED when warranted by events and/or when serving firm or management ad hoc interests. These firms' VEDs are found to be more regular, frequent, timely, and often with confirming content. Their VED (...) events, usually midquarter updates, are often prescheduled and specifically named using period-related terms. These controllable characteristics qualify it as a strategy, termed 'Period-Driven VED', in distinction from 'Event-Driven VED'. The period-driven VED strategy is found to improve a firm's information environment through a reduced information gap, measured by abnormal stock returns, lower analysts' forecast error and dispersion, and fewer surprises around earnings-release dates. The firm's improved information environment leads to lower cost of capital, as evidenced by prior theoretical and empirical research, enhancing firm value. (shrink)

The impact of emotion on executive functioning is gaining interest. It has led to the differentiation of “cool” Executive Functioning processes, such as cognitive flexibility, and “hot” EF processes, such as affective flexibility. But how does affective flexibility, the ability to switch between cognitive and affective information, vary as a function of age and sex? How does this construct relate to “cool” executive functioning and cognitive-emotion regulation processes? In this study, 266 participants, including 91 adolescents and 175 adults, completed a (...) cognitive–affective switching task with specific unpredictable switches, as well as measures of inhibition, attention, and cognitive-emotion coping strategies. We expected cognitive to affective switching to be more costly than affective to cognitive switching in females versus males, as well as higher switch costs in adolescents. Using linear mixed modelling, we analysed the effect of age, sex, and types of switching on reaction time. Results show that adolescents are slower switchers than adults, and demonstrate that females, although faster switchers than males, are slower when switching from cognitive to affective content than when they are switching from affective to cognitive content. Multiple regression analyses revealed age-specific associations between cognitive-affective switching and inhibition. These results converge with reported developmental and gender specificities in EF and emotion processing, respectively. Additionally, affective flexibility could relate to differences in vigilance and inhibition. (shrink)

In 2013, there were an estimated 50,000 individuals involved in downloading and sharing indecent images of children in the United Kingdom. This poses challenges for limited police resources. We argue that police officers can make most effective use of limited resources by prioritizing those offenders who pose the greatest risk of contact offending, by nature of demonstrable pedophilia, hebephilia or dual offending status and thus, those at highest risk must be dealt with first. What is currently lacking is a clear (...) idea of the potential scale of the problem in socio-economic terms and why, therefore, it is so important that evidence-based approaches to offender detection and investigation continue to be a top priority for funders and policy makers. A systematic literature review was undertaken to address two related questions. First, what is the scale of the problem in the UK, in terms of the number of pedophilic and hebephilic individuals who pose a risk of contact offending against a child? Second, what is the potential socio-economic burden generated by the national IIOC suspect pool if left unattended to by targeted police action? Applying population estimates of pedophilia and hebephilia to the male population, we estimate there are between 2,365–5,991 males with paedophila and 12,218–30,952 males with hebephilia who are likely contact offenders. Applying average prevalence and incidence based costing methods to a conservative estimate of one victim per offender, the combined socio-economic burden from these persons could amount to £236-£597 million increasing to £2.9-£7.3 billion. Applying the same costs to CEOP estimate of 50,000 IIOC offenders we estimate that between 6,000 and 27,500 dual offenders could have already committed past contact offenses, contributing an economic burden of between £97–£445 million increasing to £1.2–£5.4 billion. Future contact offenses could contribute a further burden of £16–£18.6 million increasing to £198–£227 million. Drawing upon these findings, we argue for the benefits of a research-informed prioritization approach to target IIOC offenders. (shrink)

Game experiments designed to test the effectiveness of reward and/or punishment incentives in promoting cooperative behavior among their participants are quite common. Results from two such recent experiments conducted in Beijing, based on the Prisoner’s Dilemma (PD) game and Public Goods Game respectively, are summarized here. The unexpected empirical outcomes for the repeated PD game, that cooperation actually decreased when the participants had the option of using a costly punishment strategy and that participants who used costly punishment in some round (...) of the repeated game often did so in the first round, are discussed in terms of differences in attitudes toward reputation in Chinese culture compared to other locations (mostly in Western society) where similar experiments have been conducted. The second experiment models an institution providing incentives to increase contribution levels (i.e., cooperation) to the public good. The results show that combined institutional reward and punishment is the most effective means to increase cooperation, followed by a scheme using only punishment. It is shown how these empirical results are related to the theoretical predictions that assume players play rationally by optimizing their personal payoff given their opponents’ actions in these multi-player games. (shrink)

The never ending growth of digital information and the availability of low-cost storage facilities and networks capacity is leading users towards moving their data to remote storage resources. Since users’ data often holds identity-related information, several privacy issues arise when data can be stored in untrusted domains. In addition digital identity management is becoming extremely complicated due to the identity replicas proliferation necessary to get authentication in different domains. GMail and Amazon Web Services, for instance, are two examples (...) of online services adopted by million of users throughout the world which hold huge amounts of sensitive users data. State-of-the-art encryption tools for large-scale distributed infrastructures allow users to encrypt content locally before storing it on a remote untrusted repository. This approach can experience performance drawbacks, when very large data-sets must be encrypted/decrypted on a single machine. The proposed approach extends the existing solutions by providing two additional features: (1) the encryption can also be delegated to a pool of remote trusted computing resources, and (2) the definition of the encryption context which drives the tool to select the best strategy to process the data. The performance benchmarks are based on the results of tests carried out both on a local workstation and on the Grid INFN Laboratory for Dissemination Activities (GILDA) testbed. (shrink)

Mild signs of postpartum depression or anxiety are present in up to half of all new mothers. However, the impact of having the “baby blues” on infant development remains largely unknown. The current study explores a potential relation between mother’s self-reported depression or anxiety symptoms and infant’s motor development in a longitudinal sample of 50 mother-infant dyads. Further, we examine whether engaging in fetal kick counting during pregnancy may reduce maternal psychopathology symptoms and thereby positively influence infant motor development and (...) parent-child engagement during the first months of life. We hypothesized that subclinical maternal psychopathology would negatively impact infant motor development, and that completing a fetal kick count activity during the third trimester would reduce overall signs of maternal psychopathology. Results only partially support these hypotheses. Postpartum maternal anxiety seems to negatively affect the emergence of infants’ fine motor skills. However, engaging in fetal kick counting during pregnancy did not reduce maternal depression or anxiety symptoms. Nevertheless, preliminary evidence suggests that engaging in fetal kick counting may impact early child development by altering the mother’s attitudes toward the child. Future research is needed to examine the value of this low-cost intervention strategy more closely. (shrink)

The PRIME Institute of the College of Pharmacy, University of Minnesota, recently released preliminary research findings indicating a trend of extraordinary pharmaceutical industry pricing of drug products in the United States (U.S.). According to researchers at the PRIME Institute, such extraordinary price increases are defined as any price increase that is equal to, or greater than, 100% at a single point in time. In some instances, PRIME Institute researchers found that drugs exhibiting extraordinary price increases are categorized as "orphan drugs" (...) (or blood-related biologic treatments) and often life-saving or life-sustaining for treating the cause or symptoms of diseases affecting fewer than 200,000 people in the U.S., or where there is prevalence of less than 5 per 10,000 people afflicted with a disease or symptoms in the community. Because of extraordinary price increases for orphan drugs — some exceeding 1000% at a single point in time -this article addresses two interrelated questions: Are extraordinary orphan drug price increases socially responsible behavior? If so, are the pharmaceutical industry's policies providing orphan drug access to American consumers in dire need of available life-sustaining and life-enhancing pharmaceuticals considered "socially responsible" behavior? The author concludes, after an interdisciplinary analysis of the legal, economic, sociopolitical, and ethical dimensions of orphan drug pricing, that they are not socially responsible – unless justified by cost and availability of health care marketplace/patient options. Furthermore, the author recommends a socially responsible industry strategic approach to insure that patients ultimately receive -regardless of cost -timely access to life-saving and life-sustaining orphan drugs. (shrink)

As the price of pharmaceuticals and biologicals rises so does the number of patients who cannot afford them. In this article, we argue that physicians have a moral duty to help patients access affordable medicines. We offer three grounds to support our argument: (i) the aim of prescribing is to improve health and well-being which can only be realized with secure access to treatment; (ii) there is no morally significant difference between medicines being unavailable and medicines being unaffordable, so the (...) steps physicians are willing to take in the first case should extend to the second; and (iii) as the primary stakeholder with a duty to put the individual patient’s interests first, the medical professional has a duty to address cost-barriers to patient care. In articulating this duty, we take account of important epistemic and control conditions that must be met for the attribution of this duty to be justified. (shrink)

Comme tous les autres projets humains, les politiques de santé publique sont souvent affectées par des imperfections et des erreurs. Cependant, elles sont mieux ancrées dans les résultats de la recherche scientifique que d’autres actions humaines en général, et politiques gouvernementales en particulier. D’une manière générale, les données sur lesquelles reposent les politiques de santé publique remplissent les conditions suivantes : méthodes de recherche rigoureuses, tests indépendants et précis, reproductibilité des résultats, mesure du taux d’erreur, capacité à écarter des hypothèses (...) rivales et un degré d’acceptation satisfaisant au sein de la communauté scientifique. Les politiques de santé publique comprennent des campagnes de vaccination de la population, en particulier des enfants. Ces actions de vaccination sont considérées comme sûres et efficaces par les institutions publiques, les organisations de santé, les médecins et les chercheurs en santé. Malgré cela, un nombre croissant de parents choisit de ne pas vacciner leurs enfants. Les fausse nouvelles sur les vaccins publiées dans les médias, en particulier dans les nouveaux médias, par les influenceurs, ont contribué certainement à cette tendance. Ces influenceurs sont insuffisamment qualifiés ou totalement non qualifiés pour commenter l’innocuité et l’efficacité des vaccins dans les médias. Par conséquent, ils ne peuvent pas produire des données fiables et des opinions qualifiées, c’est-à-dire des informations indépendantes, précises, pertinentes, fiables et complètes. Cependant, ces influenceurs parviennent à influencer, dans une large mesure, le comportement des parents en matière de vaccination. La stratégie de lutte contre les fausses nouvelles en publiant des preuves contraires est évidemment nécessaire, mais pas suffisante parce que beaucoup de fausses infos sur les vaccins fonctionnent comme des mythes. Etant fixées d’une manière partiellement irrationnelle, les mythes anti-vaccination ne peuvent être démystifiés seulement avec les dernières preuves scientifiques. C’est pourquoi il est nécessaire d’envisager des stratégies de relations publiques capables d’influencer des opinions collectives irrationnelles. (shrink)

Progress in medicine and the subsequent extension of health coverage has meant that health expenditure has increased sharply in Western countries. In the United States, this rise was precipitated in the 1980s, compounded by an increase in drug consumption which prompted the government to re-examine its financial support to care delivery, most notably in hospital care and emergencies services. In California for example, 50 emergency service providers were closed between 1990 and 2000, and nine in 1999–2000 alone. In that State, (...) only 355 hospitals (out of 568) have maintained emergency services departments (Darves, WebMB, 2001). Reforming hospital Emergency Department (ED) operations requires caution not only because the media pay a lot of attention to ED operations, but also because it raises ethical issues: this became more apparent with the enactment of the EMTALA which stipulates that federally funded hospitals are required to give emergency aid in order to “stabilize” a patient suffering from an “emergency medical condition” before discharging or transferring that patient to another facility. While in essence the law aims to preserve patient access to care, physicians assert that the EMTALA leads to more patients seeking care for non-urgent conditions in EDs (GAO, Report to Congressional Committees, 2001), leading to overcrowding, delayed care for patients with true emergency needs, and forcing hospitals to divert ambulances to other facilities resulting in further delays in urgent care. Also, fewer physicians are willing to be on-call in emergency departments because the EMTALA law requires on-call physicians to provide uncompensated care. Thus there is a need to find a balance between appropriate care to be provided to ED patients, and low costs since uncompensated care is not covered by state or federal funds. This concerns, first and foremost, hospitals that provide a greater amount of uncompensated care (e.g. hospitals serving communities with a higher population of illegal immigrants). Looking at the intrinsic causes of high ED costs, the paper first explains why costs of care provided in EDs are high, and look at a major cause of high ED costs: overcrowding and ED users’ characteristics. This is followed by a discussion on a much-debated factor: the use of EDs for non-emergency conditions, a practice which has often been accused of disproportionately raising costs. We look at various mechanisms used either to divert or prevent the patient from using ED: these include triage services; and the role of HMOs in the ED chain of care: though the US government has increasingly relied on Managed Care organizations to contain costs (e.g. Medicaid and Medicare Managed Care), do HMOs make a difference when it comes to ED costs? Of particular interest is the family physician acting as a gatekeeper, and the legislation that was enacted to protect those who bypass the referral system. We then look at the other end of the ED chain (i.e. the recipient): the financial responsibility of ED users has increased. Alternative providers such as walk-in clinics are increasingly common. EDs also attempt to reengineer their operations to curb costs. While the data are mostly applicable to a private health care system (e.g. the US), the article, using a critical assessment of the existing literature, has implications for other EDs generally, wherever they operate, since every ED faces similar funding problems. (shrink)

In the context of the widening trade gap between Japan and the U.S.A. and the increasing numbers of missions visiting Japan aimed at a better understanding of the Japanese market and Japanese business, topics such as Just in Time and TQC have received the most prominence, along with discussions of Japanese-style management and labor relations. The weakness of most discussions has been their inability to set these into the context of the highly complex Japanese value-system that runs through both business (...) and society. Once understood, it becomes apparent that there is a system of values and value-related strategies at work that have a re-inforcing effect in the directions of cooperation and efficiency. The paper will identify a number of these and indicate their areas of influence. Four are discussed: (1) the formation of corporate philosophy (2) management philosophy (3) corporate work ethic (4) supplier/customer relations. (shrink)

The aim of this conceptual paper is to discuss the issue of managing fake news in the online environment, from an organizational perspective, by using reactive PR strategies. First, we critically discuss the most important definitions of the umbrella term fake news, in the so-called post-truth era, in order to emphasize different challenges in conceptualizing this elusive social phenomenon. Second, employing some valuable contribution from literature, we present and illustrate with vivid examples 10 categories of fake news. Each type (...) of fake news is discussed in the context of organizational communication. Based on existent literature, we propose a 3D conceptual model of fake news, in an organizational context. Furthermore, we consider that PR managers can use either reactive PR strategies to counteract online fake news regarding an organization, or communication stratagems to temporarily transform the organization served into a potential source of fake news. The existing typology of reactive public relations strategies from the literature allow us to discuss the challenge of using them in counteracting online fake news. Each reactive PR strategy can be a potential solution to respond to different types of online fake news. Although these possibilities seem to be extensive, in some cases, PR managers can find them ineffective. In our view, this cluster of reactive PR strategies is not a panacea for managing fake news in the online environment and different strategic approaches may be need, such as communication stratagems. In this context, communication stratagems consist in using organization as a source or as a vector for strategic creation and dissemination of online fake news, for the benefit of the organization. We conclude that within online environment PR managers can employ a variety of reactive PR strategies to counteract fake news, or different communication stratagems to achieve organizational goals. (shrink)

Many countries, including Australia, have established a national scheme that supports the recognition of a single ethical review for multi-centre research conducted in publicly funded health services. However, local site-specific governance review processes remain decentralised and highly variable. This short report describes the ethics and governance processes required for a negligible risk national survey of physiotherapy-led airway clearance services in Australia. We detail inconsistencies in research governance document preparation and submission (platforms, processes, forms and signatories) and report the time (...) class='Hi'>cost and likely impact of these inconsistencies on health services research outcomes. Processes and strategies that facilitated success in this project are identified and summarised as helpful hints to other researchers looking to embark on negligible risk research in public health facilities. (shrink)

We present two prudent semantics within Dung's theory of argumentation. They are based on two new notions of extension, referred to as p-extension and c-extension. Two arguments cannot belong to the same p-extension whenever one of them attacks indirectly the other one. Two arguments cannot belong to the same c-extension whenever one of them indirectly attacks a third argument while the other one indirectly defends the third. We argue that our semantics lead to a better handling of controversial arguments than (...) Dung's ones. We compare the prudent inference relations induced by our semantics w.r.t. cautiousness; we also compare them with the inference relations induced by Dung's semantics. (shrink)

The block universe is generally considered as the metaphysical position that best accommodates the outcomes of relativistic physics. Its most consistent formulation postulates a static universe where change is not admitted. However, some of its advocates try to reconcile its basic adynamical commitments as to the nature of physical reality with certain aspects of dynamism that arise, for instance, within human experience. In this article, I first examine how some block viewers try to reconcile dynamism and adynamism. I then go (...) on to discuss the problems that emerge while trying to make room for dynamism within the block. To this end, I clarify the meaning of adynamism and explains what it takes to eradicate dynamism through the implementation of the so-called “Langrangian schema”. Based on this analysis, I juxtapose two resolute attempts at the formulation of a thoroughly adynamical project. The first, named relational block world, aims to make the block view totally static. The second, Barbour’s early works on the implementation of a neo-Machian relational strategy, makes the point that a complete adynamism cannot be achieved within relativity and its metaphysical counterpart. The article in conclusion argues that, by dismissing four-dimensionalism and embracing three-dimensionalism, Barbour proves better at promoting an utterly static physics. (shrink)

Climate change, rising energy costs, and other dilemmas raise the prospect for major change in energy-ecology-society relations. Two prominent proposals for change include: a nuclear power renaissance; and mega-scale renewable energy development. Both suggest that modern society will receive a rising stream of less CO2-rich kilowatt-hours, so that increased energy consumption and economic growth can continue. The article doubts these CO2 claims and finds both options lead to deepening unsustainability and environmental injustice. A third approach is proposed. A new institutional (...) and community strategy called a Sustainability Energy Utility. The SEU looks to reduce energy use and seeks to support remaining energy needs by community-scale renewables. To accomplish deep energy change, the authors show how an SEU can move society from an energy commodity to energy commons regime. Commonwealth economy and community trusts are key means to significant change: a future commons is offered as the more appropriate strategy. (shrink)

ABSTRACTA popular strategy for understanding the probabilities that arise in physics is to interpret them via reductionist accounts of chance—indeed, it is sometimes claimed that such accounts are uniquely well-suited to make sense of the probabilities in classical statistical mechanics. Here it is argued that reductionist accounts of chance carry a steep but unappreciated cost: when applied to physical theories of the relevant type, they inevitably distort the relations of probability that they take as input.

Treatment of military-related posttraumatic stress disorder is a major public health care concern. Since 2001 over 2.5 million troops have been deployed to Iraq or Afghanistan, many of whom have experienced direct combat and sustained threat. Estimates of PTSD rates related to these wars range from 8% to over 20%, or 192,000 to 480,000 individuals. Already, nearly 250,000 service members of Operations Enduring Freedom, Iraqi Freedom, and New Dawn have sought VA health care services for PTSD. This recent (...) increased need for mental health services comes in addition to the ongoing needs of Vietnam-era and other veterans who continue to suffer from PTSD. PTSD is related to high co-morbidities of other mental health difficulties, poorer physical health status, and increased medical care utilization. Such high demand for services is an important contributor to the large cost associated with combat-related PTSD. Accordingly, promoting successful, cost-effective treatment strategies for PTSD is a chief public health care priority. (shrink)

With increasing awareness of environmental issues, there has been rising demand for environmental-friendly business practices. Prior research has shown that the implementation of environmental management practices is influenced by existing and potential stakeholder groups in the form of external pressures from legislators, environmental groups, financial institutions and suppliers, as well as internally by employees and owner/manager attitudes and knowledge. However, it has been reported that despite business owner/managers having strong “green” attitudes, the level of implementation of environmental-friendly practices is low. (...) In order to explore the connection between pressures for improved practices and the management actions taken, this article examines how influence from various stakeholders is related to awareness of environmental issues, and how this awareness relates to actions taken within the businesses to reduce the environmental impact of their operations. The results indicate that legislation does result in general environmental awareness, and that organizations are then willing to␣change their business processes and environmental strategies. However, despite their actions they have little awareness of the benefits that might arise from cost reductions from their environmental-friendly practices. Those influenced by their suppliers act to reduce waste, but do not put into place formal environmental management systems, or use environmental messages to market their goods or services. Nevertheless, it can be argued that they have a real commitment to environmental issues, as evidenced by a willingness to voluntarily contribute to environmental organizations. (shrink)

To address the growing costs associated with chronic illness care, many countries, both developed and developing, identify increased patient self‐management or self‐care as a focus of healthcare reform. Health coaching, an implementation strategy to support the shift to self‐management, encourages patients to make lifestyle changes to improve the management of chronic illness. This practice differs from traditional models of health education because of the interactional dynamics between nurse and patient, and an orientation to care that ostensibly centres and empowers patients. (...) The theoretical underpinnings of coaching reflect these differences, however in its application, the practices arranged around health coaching for chronic illness self‐management reveal the social regulation and professional management of everyday life. This becomes especially problematic in contexts defined by economic constraint and government withdrawal from activities related to the ‘care’ of citizens. In this paper, we trace the development of health coaching as part of nursing practice and consider the implications of this practice as an emerging element of chronic illness self‐management. Our purpose is to highlight health coaching as an approach intended to support patients with chronic illness and at the same time, problematize the tensions contained in (and by) this practice. (shrink)

This paper explores the possibility of a standard legal language (e.g. English) for a principled evolution of law in line with technological development. In doing so, reference is made to blockchain networks and smart contracts to emphasise the discontinuity with the liberal legal tradition when it comes to decentralisation and binary code language. Methodologically, the argument is built on the underlying relation between law, semiotics and new forms of media adding to natural language; namely: code and symbols. In what follows, (...) I will concentrate on the study of factors that explain why such approach can be fruitful for the future of law and innovation. I have three reasons for selecting this topic. The first is a more pragmatic reason, based on my current research of law as a linguistic phenomenon. Secondly, the topic does also touch the matter on binary code language, rivalrous to legal alphabetic language. Lastly, the study aims at emphasizing the pivotal role of the jurist as an interpreter in a changing society accommodating diverging realms of reality. The study is structured as follows. Firstly, a quick exam of the traits of blockchain networks would provide the contextual link to establish the arguments in support of the need of a standard legal language. Secondly, a comparison between liberal legal institutions and theory of semiotics is set to perceive their functioning and ascertain their limits in the light of todays unprecedented changes. Thirdly, a summary on blockchain networks’ legal features would constitute the thrust behind the idea of a uniform legal language. Methodologically, the argument does also establish some relations with classical laws of physics and philosophy of media. Its aim is to demonstrate how the suggested legal interpretation and semiotic-based approach can contribute to overcome existing stumbling blocks including, but not limited to, the lack of cooperation at the international level as well as the gap in State norms when it comes to innovation. In this sense, the proposed strategies do not intend to replace current advances in the legal thought. In contrast, it seeks to harmonise their results providing a methodical approach that can concur to inform a new technique to address new controversial issues. In practice, the proposed method regarding the adoption of a uniform legal language would lower transactive costs in terms of normative coordination in the matter of international cooperation and in the definition of applicable law among different legal systems. Alternatively, it might contribute to the convergence of legal systems and/or their underlying concepts. Differently put, article’s contribution can be envisaged in fostering juridical consistency with regards to different forms of languages’ coexistence. (shrink)

Intensive research is carried out to develop a disease-modifying drug for Alzheimer’s disease. The development of drug candidates that reduce Aß or tau in the brain seems particularly promising. However, these drugs target people at risk for AD, who must be identified before they have any, or only moderate, symptoms associated with the disease. There are different strategies that may be used to identify these individuals. Each of these strategies raises different ethical challenges. In this paper, we analyse (...) these challenges in relation to the risk stratification for AD necessary for using these drugs. We conclude that the new drugs must generate large health benefits for people at risk of developing AD to justify the ethical costs associated with current risk stratification methods, benefits much larger than current drug candidates have. This conclusion raises a new set of ethical questions that should be further discussed. No data are available. (shrink)

In this introduction to the Topical Collection on Social and Cognitive Diversity in Science, we map the questions that have guided social epistemological approaches to diversity in science. Both social and cognitive diversity of different types is claimed to be epistemically beneficial. The challenge is to understand how an increase in a group’s diversity can bring about epistemic benefits and whether there are limits beyond which diversity can no longer improve a group’s epistemic performance. The contributions to the Topical Collection (...) discuss various proposals to maintain an appropriate amount of cognitive diversity in science, for instance, by recruiting and retaining practitioners from underrepresented social groups, providing incentives for explorative and risky research, encouraging interdisciplinary collaborations and stakeholder participation in research, requiring industry scientists to share their evidence, and developing strategies to encounter politically motivated attempts to manufacture doubt. To be successful, efforts to promote diversity in science should anticipate risks related to institutional interventions, navigate trade-offs between different types of epistemically good outcomes, and identify hidden costs that such policies may cause for various actors. Such efforts need to be assessed not only from an epistemic perspective but also from the point of view of fairness and the political legitimacy of scientific institutions. (shrink)

Climate has a strong influence on urban planning and also plays a fundamental role in soil composition affecting the character of plants and animals. The climate is a combination of different meteorological factors that characterized a specific region over a specific time. The movement of the Sun and Earth inclination toward it is the most important factors which determine the characteristics of the climate. The global movement of the air from equator toward poles and vice versa influences also drastically the (...) climate change. In this section are also included breezes. Also air relative humidity plays an important role shaping the climate. It plays a very important role in cloud formation. The built environment can influence the urban climate of the city through height, form, and applied building materials. Building form and shape, building materials, openings in the façade, and their orientation often are determined by climate parameters. Urban density, directions, and street network and their shape are related to the climate change, apart from topography. Density of urban structures produces important effects on the microclimatic conditions in external spaces. The bioclimatic behavior of each type of outdoor spaces depends on the relationship with its surrounding elements. The city of Tirana is included in Mediterranean climate characterized by hot dry summers and mild cold wet winters with high daily thermal excursions. All of the countries bordering the Mediterranean Sea benefit from the Mediterranean climate. Specifically spotted, Tirana is part of Mediterranean coastal zone (<22 °C in temperature) with an annual temperature of 15.3 °C. In the inner city can be found areas with high pollution, which normally contain a high percentage of business and industry, settlements, and traffic, so-called “sealed” areas. They constitute “hyperthermic areas” or “heat islands”. The term “heat island” describes built-up areas which are hotter than nearby rural areas. Heat islands can affect communities by increasing summertime peak energy demand, air-conditioning costs, air pollution, greenhouse gas emissions, heat-related illness and mortality, and water quality. The aim of the bioclimatic design is also the reduction of the heat-island phenomenon. The use of materials with different energy absorption capabilities and integration of green spaces into urban life is important. The vegetation effects on microclimate and in the built environment are present. Trees are necessary and indispensable to human life. They provide shelter for us, provide food, and their fibers cloth us. Implementation of the green belts in the city is one of the strategies in order to reduce heat-island effect. Vegetation also can provide a deep feeling of attachment to certain places and trees which are part of it. The use of trees avoids monotony and ensures diversification. They play a crucial role creating microclimates which influence the thermal comfort of people reducing heating or cooling loads. Vegetation also creates cooler microclimates around the building through evapotranspiration, reduces wind speed, regulates humidity, and reduces temperature. It is observed that tree species have a greater influence on humidity than on temperature. Trees can also absorb and reduce the reverberation time of the sound, behaving as sound buffers. The benefits of tree plantation in the inner city are enormous and they can’t be neglected. (shrink)

The World Health Organisation encourages that blood donation becomes voluntary and unremunerated, a system already operated in the UK. Drawing on public documents and videos, this paper argues that blood donation is regarded and presented as altruistic and supererogatory. In advertisements, donation is presented as something undertaken for the benefit of others, a matter attracting considerable gratitude from recipients and the collecting organisation. It is argued that regarding blood donation as an act of supererogation is wrongheaded, and an alternative account (...) of blood donation as moral obligation is presented. Two arguments are offered in support of this position. First, the principle of beneficence, understood in a broad consequentialist framework obliges donation where the benefit to the recipient is large and the cost to the donor relatively small. This argument can be applied, with differing levels of normativity, to various acts of donation. Second, the wrongness of free riding requires individuals to contribute to collective systems from which they benefit. Alone and in combination these arguments present moral reasons for donation, recognised in communication strategies elsewhere. Research is required to evaluate the potential effects on donation of a campaign which presents blood donation as moral obligation, but of wider importance is the recognition that other-regarding considerations in relation to our own as well as others’ health result in a range not only of choices but also of obligations. (shrink)

We examine corporate philanthropic decisions in response to the local spread of COVID-19. From a strategic perspective, firms may proactively undertake philanthropic efforts to limit the spread of the pandemic and avoid a degraded business environment. From the perspective of non-trivial costs, increased economic uncertainty can raise concerns about business survival and lead to conservative philanthropic strategies. Following the proverb “prosperity makes friends, adversity tries them,” at the provincial level, our results support the second perspective. Specifically, when the spread (...) of the pandemic worsens in a province, local firms are less likely to make COVID-19-related donations in terms of likelihood and amount. Investors also react negatively, not only to the local spread of COVID-19 but also to COVID-19-related philanthropic donations. At the organizational level, our evidence indicates that there is at least some level of cost–benefit analysis underlying corporate philanthropic decisions. Specifically, corporate philanthropic donations, especially those made to the local business environment, are significantly affected by organizational-level factors, such as pre-existing resource availability and motives to acquire political and reputational resources. Overall, our multilevel study presents a comprehensive picture of corporate philanthropic decisions amid the COVID-19 crisis. (shrink)

The COVID-19 pandemic has deeply influenced the tourism and hospitality industry, and it has also reshaped people’s travel preferences and related behaviors. As a result, how prospective travelers perceive travel constraints and their effects on future travel behaviors may have changed to some extent. Besides, such perception arguably varies across gender. Therefore, this research examines the interplay between travel constraints, gender, and travel intentions for facilitating robust tourism recovery by revisiting the Leisure Constraints Model from a gender perspective. Data (...) were collected through a survey from 357 Malaysian prospective travelers. By conducting path analysis and multigroup analysis, it is found that structural and interpersonal constraints impose indirect effects on travel intentions, and gender moderating the effect of structural cost on intrapersonal constraints and effect of intrapersonal constraints on travel intentions. Based on these findings, this research provides theoretical and practical implications into how to adjust their marketing strategies and travel products during the era of “new normal” for tourism policy makers, destination marketers, and related businesses. (shrink)

Alasdair MacIntyre described the late modern West as driven by two moral values: efficiency and effectiveness. Regardless of whether you accept MacIntyre's overarching story, it seems clear that efficiency and effectiveness have achieved a zenith in institutional health care structures, such that these two aspects of care become the final arbiters of what counts as “good” care. At the very least, they are dominant in many clinical contexts and act as the interpretative lens for the judgments of successful health care (...) managers. The drive of efficiency can also be seen in “lean” management methods (originally imported from the automotive manufacturing industry) increasingly deployed in the intensive care unit. This drive gives us pause. The high stress of the ICU is exacerbated by the enormous complexity of technological interventions designed to maintain physiological functioning as the body heals, as well as the ever‐present concerns related to cost, effectiveness, and efficiency. The ICU, therefore, provides an illustrative view of the challenges facing clinicians, as well as resource managers, in terms of delivering care. In short, the goal of technocratic efficiency often ends up at odds with humane purposes. To better understand these contemporary health care dynamics, we conducted a limited series of focus group discussions and interviews with residents experienced in the challenges of delivering care in the ICU environment. In what follows, we highlight some narrative observations drawn from these focus groups. We found a recurrent and disconcerting refrain among our informants that has not been adequately described or addressed in the literature: technocratic management techniques have crept into and bifurcated clinical care strategies in the ICU. Specifically, we highlight the influence of concerns around efficiency and effectiveness and the ways in which these foci have contributed to a bifurcation in care in the ICU along two trajectories: either compassionate care or curative care. (shrink)

From 2010 to 2020, Indonesia’s tax-to-gross domestic product (GDP) ratio has been declining. A tax-to-GDP ratio trend of this magnitude indicates that the tax authority lacks the capacity to collect taxes. The tax administration system’s modernization utilizing information technology is thus deemed necessary. Artificial intelligence (AI) technology may serve as a solution to this issue. Using the theoretical frameworks of innovations in tax compliance, the cost of taxation, success factors for information technology governance (SFITG), and AI readiness, this study (...) aims to analyze the costs and benefits, the enablers and inhibitors, and the readiness of the government and related parties to apply AI to modernize the tax administration system in Indonesia. This study used qualitative approaches for the data’s collection and analysis. The data were obtained through a literature study and in-depth interviews. The findings show that AI application in the field of taxation can assist tax authorities in enforcing the law, provide taxpayers with convenience in fulfilling their tax obligations, improve justice for all taxpayers, and reduce tax compliance costs. The openness of Indonesia to technological developments, as evidenced by the AI National Strategy, is a supporting factor in the application of AI in Indonesia, particularly for the modernization of the tax administration system. The absence of specific regulations governing AI adoption, as well as a lack of human resources that can help the tax administration process, data, and infrastructure already support, are the impediments to implementing AI for the modernization of the tax administration system in Indonesia. (shrink)

In recent years, documentary formats have entered prominently into the realm of the culture industry, especially since Hollywood and Netflix started to invest in costly productions addressed to the mainstream. Many of these documentaries claim to show reality in its immediacy (“as it really is”), to reveal that which is obscured, or to critically assess societal evils. They use aesthetic strategies that reinforce the appearance of authenticity, while concealing the mediation of what they represent, and the authoritarian stances they (...) presuppose. This turns them into powerful instruments for diffusing authoritarian and populist ideologies. Their political impact on society, their performative power of opinion-shaping, and their subliminal influence on how we perceive and understand reality call urgently for critical assessment. Horkheimer and Adorno’s critique of the culture industry, along with their philosophical, sociological, and aesthetic writings, provide a constructive starting point. This essay aims to mobilize their critical theory of society for the problematization of documentary films in terms of their dialectical relation to society. (shrink)

The development of gene expression profiling and next-generation sequencing technologies have steered oncogenomics to the forefront of precision medicine. This created a need for harmonious cooperation between clinicians and researchers to increase access to precision oncology, despite multiple implementation challenges being encountered. The aim is to apply personalised treatment strategies early in cancer management, targeting tumour subtypes and actionable gene variants within the individual’s broader clinical risk profile and wellbeing. A knowledge-generating database linked to the South African Medical Research (...) Council’s Genomic Centre has been created for the application of personalised medicine, using an integrated service and research approach. Insights gained from patient experiences related to tumour heterogeneity, access to targeted therapies and incidental findings of pathogenic germline variants in tumour DNA, provided practice-changing evidence for the implementation of a cost-minimisation pathology-supported genetic testing strategy. Integrating clinical care with genomic research through data sharing advances personalised medicine and maximises precision oncology benefits. (shrink)