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)

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)

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)

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)

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)

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)

Major depressive disorder is a highly prevalent psychiatric disorder, and recurrent depression is associated with severe and chronic impairment. Identifying markers of risk is imperative to i...

Reorienting the Political examines the reception of two controversial German philosophers, Carl Schmitt and Leo Strauss, in the Chinese-speaking world. This volume explores the powerful resonance of both thinkers in Chinese political thought from a cross-cultural and interdisciplinary perspective.

Background eHealth was widely used during the COVID-19 pandemic. Much attention was given to the technical aspects of eHealth, such as infrastructure and cost, while the soft skill of compassion remained underexplored. The wide belief in compassionate care is more compatible with in-person interactions but difficult to deliver via e-platforms where personal and environmental clues were lacking urges studying this topic. Purpose to explore the experience of delivering compassionate care via an eHealth platform among healthcare professionals working to contain the (...) COVID-19 pandemic. Methods A qualitative study design with an interpretative phenomenological analysis approach was used. Twenty healthcare professionals (fifteen nurses and five physicians) who provided care using technology platforms, such as telephone hotlines, mobile apps, and social media, were interviewed individually. Ethical considerations Permission to conduct the study was obtained from the Institutional Review Board. Results Participants stated that “eHealth enabled compassionate care during the pandemic” by ensuring patient care availability and accessibility. They shared experiences of “communicating compassionate care via eHealth” with suggestions of addressing patients’ needs with empathy, adopting a structured protocol to guide eHealth communication, and using more advanced visual-media methods to promote human-to-human interaction. They recommended “setting realistic mutual expectations” considering the limitations of eHealth in handling complex health situations and staffing shortages. Participants considered “low eHealth literacy hinders compassion.” Additionally, they recommended the need for “institutional/system-level support to foster compassionate care.” Conclusion Participants recognized the importance of integrating compassion into eHealth services. Promotion of compassionate care requires standardization of eHealth services with institutional and system-level support. This also includes preparing adequate staffing who can communicate compassionate care via eHealth, set realistic expectation, and adjust communication to eHealth literacy level while meeting the needs of their patients. (shrink)

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.

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)

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)

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)

Over the past two decades, Victor and Cullen's (Adm Sci Q 33:101-125, 1988) typology of ethical climates has been employed by many academics in research on issues of ethical climates. However, little is known about how managerial practices such as communication and empowerment influence ethical climates, especially from a functional perspective. The current study used a survey of employees from Taiwan's top 100 patent-owning companies to examine how communication and empowerment affect organizational ethical climates. The results confirm the relationship between (...) these two managerial practices and organizational ethical climates. We discuss our results and their implications for both future academic research and practice. (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)

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)

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)

Improving the resilience of urban road networks suffering from various disruptions has been a central focus for urban emergence management. However, to date the effective methods which may mitigate the negative impacts caused by the disruptions, such as road accidents and natural disasters, on urban road networks is highly insufficient. This study proposes a novel adaptive signal control strategy based on a doubly dynamic learning framework, which consists of deep reinforcement learning and day-to-day traffic dynamic learning, to improve the network (...) performance by adjusting red/green time split. In this study, red time split is regarded as extra traffic flow to discourage drivers to use affected roads, so as to reduce congestion and improve the resilience when urban road networks are subject to different levels of disruptions. In addition, we utilize the convolution neural network as Q-network to approximate Q values, link flow distribution and link capacity are regarded as the state space, and actions are denoted as red/green time split. A small network is utilized as a numerical example, and a fixed time signal control and other two adaptive signal controls are employed for the comparisons with the proposed one. The results show that the proposed adaptive signal control based on deep reinforcement learning can achieve better resilience in most of the cases, particularly in the scenarios of moderate and severe disruptions. This study may shed light on the advantages of the proposed adaptive signal control dealing with major emergencies compared to others. (shrink)

While prior research suggests a link between mindfulness and ethical decision-making, most of the evidence for this link is correlational and refers to self-focused ethical behaviors. The paucity of experimental evidence, coupled with a lack of clarity on what mechanisms underlie the effect, limits our understanding of whether and how mindfulness might foster other-focused ethical behaviors. In this research, we hypothesize that state mindfulness might promote other-focused ethical behaviors by increasing resourcefulness, which we define as a perceived state of resource (...) abundance. Across four experimental studies, we report causal evidence for the effects of state mindfulness instantiated through brief mindful meditation exercises on other-focused ethical behaviors, including choice of fair-trade products, charitable giving, and volunteering. Resourcefulness mediates the effects of mindfulness on other-focused ethical behaviors. Our work answers the call for more experimental research on mindfulness and its important implications for ethical decision-making. (shrink)

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.

The structure of Au layers deposited by sputtering on oxidized p-type Si substrates is investigated by a combination of scanning electron microscopy and scanning probe microscopy. The effect of the temperature on the grain structure of the layers has been determined, revealing that an annealing temperature of 300° C results in a larger grain size and smoother surfaces but generates some cracks in the film surface. At an annealing temperature of 500° C, further grain growth is observed, but a high (...) density of cracks and voids also results while there is little enhancement regarding the smoothness of the grain surfaces. (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)

As a result of the COVID-19 pandemic people have endured potentially stressful challenges which have influenced behaviors such as eating. This pilot study examined the effectiveness of two brief interventions aimed to help individuals deal with food cravings and associated emotional experiences. Participants were 165 individuals residing in United Kingdom, Finland, Philippines, Spain, Italy, Brazil, North America, South Korea, and China. The study was implemented remotely, thus without any contact with researchers, and involved two groups. Group one participants were requested (...) to use daily diaries for seven consecutive days to assess the frequency of experience of their food cravings, frequency of giving in to cravings, and difficulty resisting cravings, as well as emotional states associated with their cravings. In addition to completing daily food diaries, participants in group two were asked to engage in mindful eating practice and forming implementation intentions. Participants assessed their perceived changes in eating, wellbeing, and health at the beginning and end of the intervention. Repeated measures MANOVAs indicated that participants experienced significantly less food cravings, as well as lower intensities of unpleasant states associated with cravings across time. In contrast to our hypothesis, the main effects of the group were not significant. Participants reported less eating and enhanced wellbeing at the end of the study. Our findings can be used to inform future remote interventions to manage food cravings and associated emotions and highlight the need for alternative solutions to increase participant engagement. (shrink)