Reinforcing medical authority: clinical ethics consultation and the resolution of conflicts in treatment decisions

Despite substantial efforts in the past 15 years to professionalise the field of clinical ethics consultation, sociologists have not re‐examined past hypotheses about the role of such services in medical decision‐making and their effect on physician authority. In relation to those hypotheses, we explore two questions: (i) What kinds of issues does ethics consultation resolve? and (ii) what is the nature of the resolution afforded by these consults? We examined ethics consultation records created between 2011 and mid‐2015 at a large tertiary care US hospital and found that in most cases, the problems addressed are not novel ethical dilemmas as classically conceived, but are instead disagreements between clinicians and patients or their surrogates about treatment. The resolution offered by a typical ethics consultation involves strategies to improve communication rather than the parsing of ethical obligations. In cases where disagreements persist, the proposed solution is most often based on technical clinical judgements, reinforcing the role of physician authority in patient care and the ethical decisions made about that care.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154312/1/shil13003.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154312/2/shil13003_am.pd

Localized knowledge spillovers and patent citations: A distance-based approach (revised version)

経済学 / EconomicsWe develop a new distance-based test of localized knowledge spillovers that embeds the concept of control patents. Using microgeographic data, we identify localization distance for each technology class while allowing for spillovers across geographic units. We revisit the debate by Thompson and Fox-Kean (2005a,b) and Henderson, Jaffe and Trajtenberg (2005) on the existence of localized knowledge spillovers, and find solid evidence supporting localization even when using fine-grained controls. We further relax the assumption of perfect controls, and show that our distance-based test detects localization for the majority of technology classes unless hidden biases induced by imperfect controls are extremely large.JEL Classification Codes: O31, R12http://www.grips.ac.jp/list/jp/facultyinfo/okamoto_ryosuke

シカク ショウガイシャ ヘ ノ シンキュウ キョウイク ニ オケル オントロジー ベース キョウザイ ノ ユウコウセイ

我々は視覚障害者向けの鍼灸、特に経絡と経穴に関する教育材料の研究に取り組んだ。この教材では、鍼灸分野における概念間の関係の体系的な理解を可能にすべく、オントロジーを用いた。オントロジーの概念図によりオントロジー教材を作成し、これを鍼灸の講義で使用した群とオントロジー教材未使用群とで経絡・経穴の試験の結果を比較し、その有効性を解析した。その結果、オントロジー教材を使用した学生の経絡・経穴の試験の得点は、オントロジー教材未使用群の学生の得点よりも有意(P < 0.001)に高く、経絡と経穴の学習にオントロジー教材有効である事が明らかになった。この結果は、オントロジーの視覚障害者教育への利用が視覚障害者の鍼灸理論の学習へも有効であることを示唆している。In this study we developed learning material of acupuncture - acupoints and meridians - for visually impaired people. For this learning material, we used ontology to construct the relations between the concepts in the acupuncture and moxibustion field which also enables tactical understanding similarly as visual understanding. We then used our learning material in the acupuncture lecture for the visually impaired students, and quantitatively analysed its efficacy to compare the results with the group which did not use the learning material. As a result, the students, who used our learning material, scored significantly higher in the examination than the students of non-use group (P < 0.001), suggesting that our learning material was effective for learning of acupuncture theory

Cuban Lt. Nicolas Franco Andual monument, El Viso

A monument at El Viso to Cuban officer Lt, Nicolas Franco Andual who was killed during the battle while assualting El Viso

A Cruiser

Glass Slide - Cruiser - Possibly USS Orego

Soldiers at Fort in San Juan

Glass slide - San Juan, soldiers at for

1st and 10th Cavalry Monument at Las Guasimas

Detail of the plaque commemorating the figth at Las Guasimas and the role of the 1st U.S. Volunteer Cavalry and the 10th U.S. Cavalr

Cargo Ship Deck

Glass Slide - Cargo Ship Dec

Army of the Society of Santiago plaque at El Viso

The plaque on the monument at El Viso commemorates the battle fought there and at El Caney. The plaque was placed by the Society of Santiago, a U.S. veterans group whose members served in Cuban during the war of 189

Monument to builder of San Juan Hill park

Monument to the Cuban builder of the memorial park at San Juan Heights, Jose Gonzales Valde