This article is an attempt by Japanese physicians to introduce the practice patterns and moral justification of Japanese critical care to the world. Japanese health care is characterized by the fact that the fee schedule does not reward high technology medicine, such as surgery and critical care. In spite of the low reimbursement, our critical care practice pattern is characterized by continuing futile treatment for terminal patients in the intensive care unit (ICU). This apparently wasteful practice can be explained by (...) fundamental Japanese cultural values, social factors in Japan, the availability of extensive insurance coverage, physicians' psychological factors, lack of cost-benefit considerations and the pragmatic approach the Japanese take to situations. We attempt to make some brief suggestions regarding the improvement of our critical care practices. Although we can not fully present quantitative data to support our argument, this article represents our real-world approaches to the ethical issues in the ICU in Japan. (shrink)

This article constructs a static model of information acquisition when the agent does not know exactly what pieces of information he is missing. A representation of preferences over information channels and menus of lotteries is shown by adapting the model of unforeseen contingencies by Dekel et al. (Econometrica 69:891–934, 2001; Econometrica 75:591–600, 2007), which is an extension of Kreps (Econometrica 47:565–576, 1979; Economic analysis of markets and games: essays in honor of Frank Hahn, 1992). Also, characterisation of informativeness of an (...) information channel analogous to the one by Blackwell (Ann Math Stud 24:265–272, 1953) is examined in conjunction with the preference for flexibility by applying the structure of Shapley value. (shrink)

This article seeks to illuminate the figure of the child in democratic politics by arguing that children play a constitutive role as temporary outsiders who present both renewal and risk to the demos. Using Hannah Arendt’s concept of natality, we begin with an ontological account of children as new individuals that are central to renewing democratic freedom and plurality. In the second section, we explore how children can be conceived in terms of political risk by focussing on Arendt’s debate with (...) Ralph Ellison concerning the desegregation of American schools in the 1960s. Their arguments about whether children should appear in politics underscores the constitutive role that child–adult relationships play in debates about the normative fabric of democratic society. Finally, we use the radical democratic theory of Chantal Mouffe to argue that children can be characterised as an excluded group of potential adversaries that appear in political contests over claims to represent the demos. From this perspective, the article reveals that children are central figures in democratic politics because they are constituents of an unknown future polity. (shrink)

Fairness and justice are longstanding constructs in the discussions around ethics and morality. And fairness, or the principle of procedural fairness, as the bedrock of Ombuds practice in Canada, creates a responsibility for Ombuds to advance and hold institutions and individuals accountable to ethical processes and decisions. While effective conflict engagement forms a significant part of our work as well, Canadian Ombuds practice is firmly founded on and delivered through a fairness lens. Fairness has been described as a flexible and (...) context-specific construct, its content to be determined by the individual circumstances of the case. In this flexible approach lies the opportunity for Ombuds to help humanize bureaucracy for those who must navigate it, by encouraging rules, processes and decisions that support the diversity and multiplicity of contexts, experiences and perspectives. It gives Ombuds a way to define fairness that does not mean treating everyone the same, which is an interpretation of “fairness” that actually creates and perpetuates inequity and unfairness. This is supported by Canadian jurisprudence from the Supreme Court of Canada that embeds equality and inclusivity into the concept of fairness. The Charter of Rights and Freedoms, Canadian values and the diversity of the Canadian populace inform the standard of fairness in a way that support Ombuds to advance fairness in a way that is inextricable from equity. (shrink)

Recent developments in information technology and Web services have increased the potential for creating more rapid and extensive social networks and business relationships. Web 2.0 technologies, commonly referred to as online social media, have become important tools within the growth of information and communication technology (ICT) in the last few years. Web 2.0 tools such as blogs, Wiki and other services, which are widely used by individuals, also have an effect on customer relationship management (CRM) systems. Consequently, social CRM (SCRM) (...) is emerging as a new paradigm for integrating social networking in more traditional CRM systems. However, social CRM is yet to be fully utilised as a value-adding tool in improving customer relationships. This paper reports on a scoping study that explored the current situation of CRM adoption in banking industry in Saudi Arabia. The aim of this paper is to identify the factors that may influence businesses and customers’ adoption of social CRM. Various models have been proposed to study ICT and information systems acceptance and usage. This paper proposes an enhancement to one of these models, specifically the Technology Acceptance Model (TAM), by incorporating a range of factors identified in the social networking and business relationships literature believed to influence social CRM adoption. In particular, the model proposes that familiarity, caring behaviour, sharing information and perceived trustworthiness can generate cognitive view about the relationships between employees and customers. This view besides Web 2.0 features may offer a way of analysing the potential adoption of social CRM. (shrink)

Pyridoxal 5′‐phosphate, the vitamin B6 derivative, acts as the coenzyme of many enzymes involved in amino acid metabolism. Exceptionally, this compound was found covalently bound to glycogen phosphorylase, the key enzyme in the regulation of glycogen metabolism. Although it is essential for the function of phosphorylase, its direct role has remained an enigma. We have recently found that the glucose moiety of pyridoxal (5′)diphospho (1)‐α‐D‐glucose, a conjugate of pyridoxal 5′‐phosphate and glucose 1‐phosphate through a pyrophosphate linkage, is transferred to the (...) nonreducing end of glycogen, forming a new α‐1,4‐glucosidic linkage. This finding emphasizes the importance of the direct phosphate‐phosphate interaction between the coenzyme and the substrate in the phosphorylase catalytic reaction. We have proposed a catalytic mechanism for phosphorylase in which the phosphate group of pyridoxal 5′‐phosphate acts as an electrophile to the phosphate group of glucose 1‐phosphate. This appears to represent the first instance of the direct involvement of a phosphate group in catalysis by enzymes. (shrink)

In this paper it is argued that a proper understanding of the justification of perceptual beliefs leaves open the possibility that normal humans, unaided by microscopes, could genuinely know, by direct observation, of the existence of a theoretical entity like an electron. A particular theory of justification called perceptual responsibilism is presented. If successful, this kind of view would undercut one line of argument that has been given (for example, by Bas van Fraassen) in support of scientific anti-realism. Various objections (...) to the idea that electrons can be directly observed are also considered. (shrink)

Background: Patients in different countries have different attitudes toward self‐determination and medical information. Little is known how much respect Japanese patients feel should be given for their wishes about medical care and for medical information, and what choices they would make in the face of disagreement. Methods: Ambulatory patients in six clinics of internal medicine at a university hospital were surveyed using a self‐administered questionnaire. Results: A total of 307 patients participated in our survey. Of the respondents, 47% would accept (...) recommendations made by physicians, even if such recommendations were against their wishes; 25% would try to persuade their physician to change their recommendations; and 14% would leave their physician to find a new one. Seventy‐six percent of the respondents thought that physicians should routinely ask patients if they would want to know about a diagnosis of cancer, while 5% disagreed; 59% responded that physicians should inform them of the actual diagnosis, even against the request of their family not to do so, while 24% would want their physician to abide by their family's request and 14% could not decide. One‐third of the respondents who initially said they would want to know the truth would yield to the desires of the family in a case of disagreement. Interpretations: In the face of disagreement regarding medical care and disclosure, Japanese patients tend to respond in a diverse and unpredictable manner. Medical professionals should thus be prudent and ask their patients explicitly what they want regarding medical care and information. (shrink)