Critically impaired infants and end of life decision making : resource allocation and difficult decisions

Decisions to withdraw or withhold life-sustaining treatment are contentious, and offer difficult moral dilemmas to both medical practitioners and the judiciary. This issue is exacerbated when the patient is unable to exercise autonomy and is entirely dependent on the will of others.This book focuses on the legal and ethical complexities surrounding end of life decisions for critically impaired and extremely premature infants. Neera Bhatia explores decisions to withdraw or withhold life-sustaining treatment from critically impaired infants and addresses the controversial question, which lives are too expensive to treat? Bringing to bear such key issues as clinical guidance, public awareness, and resource allocation, the book provides a rational approach to end of life decision making, where decisions to withdraw or withhold treatment may trump other competing interests.The book will be of great interest and use to scholars and students of bioethics, medical law, and medical practitioners.

Does banks’ dual holding affect bank lending and firms’ investment decisions? Evidence from China

This study investigates the effect of banks’ dual holding on bank lending and firms’ investment decisions using a sample of listed firms in China. We find that dual holding leads to easier access to bank loans, a result that is more pronounced for non-state-owned enterprises (non-SOEs) than SOEs. We also find that dual holding distorts banks’ lending decisions and harms the investment efficiency for SOEs, while resulting in optimal lending decisions and enhanced investment efficiency for non-SOEs. For non-SOEs, further analysis suggests that optimal lending decisions and efficient investment can be achieved for firms with higher ownership concentration, and firms in which the family and foreign investors are the controlling shareholders. We argue that, in emerging markets, whether a bank plays a monitoring role by directly holding the debt and equity claims of companies relies heavily on whether the potential collusion between firm executives and bank managers can be averted, which in turn is determined by the firms’ governance framework and ownership structure.

Making robust policy decisions using global biodiversity indicators

In order to influence global policy effectively, conservation scientists need to be able to provide robust predictions of the impact of alternative policies on biodiversity and measure progress towards goals using reliable indicators. We present a framework for using biodiversity indicators predictively to inform policy choices at a global level. The approach is illustrated with two case studies in which we project forwards the impacts of feasible policies on trends in biodiversity and in relevant indicators. The policies are based on targets agreed at the Convention on Biological Diversity (CBD) meeting in Nagoya in October 2010. The first case study compares protected area policies for African mammals, assessed using the Red List Index; the second example uses the Living Planet Index to assess the impact of a complete halt, versus a reduction, in bottom trawling. In the protected areas example, we find that the indicator can aid in decision-making because it is able to differentiate between the impacts of the different policies. In the bottom trawling example, the indicator exhibits some counter-intuitive behaviour, due to over-representation of some taxonomic and functional groups in the indicator, and contrasting impacts of the policies on different groups caused by trophic interactions. Our results support the need for further research on how to use predictive models and indicators to credibly track trends and inform policy. To be useful and relevant, scientists must make testable predictions about the impact of global policy on biodiversity to ensure that targets such as those set at Nagoya catalyse effective and measurable change.

Testing the focal species approach to making conservation decisions for species persistence

Aim: Most risk assessments and decisions in conservation are based on surrogate approaches, where a group of species or environmental indicators are selected as proxies for other aspects of biodiversity. In the focal species approach, a suite of species is selected based on life history characteristics, such as dispersal limitation and area requirements. Testing the validity of the focal species concept has proved difficult, due to a lack of theory justifying the underlying framework, explicit objectives and measures of success. We sought to understand the conditions under which the focal species concept has merit for conservation decisions. Location: Our model system comprised 10 vertebrate species in 39 patches of native forest embedded in pine plantation in New South Wales, Australia. Methods: We selected three focal species based on ecological traits. We used a multiple-species reserve selection method that minimizes the expected loss of species, by estimating the risk of extinction with a metapopulation model. We found optimal reserve solutions for multiple species, including all 10 species, the three focal species, for all possible combinations of three species, and for each species individually. Results: Our case study suggests that the focal species approach can work: the reserve system that minimized the expected loss of the focal species also minimized the expected species loss in the larger set of 10 species. How well the solution would perform for other species and given landscape dynamics remains unknown. Main conclusions: The focal species approach may have merit as a conservation short cut if placed within a quantitative decision-making framework, where the aspects of biodiversity for which the focal species act as proxies are explicitly defined, and success is determined by whether the use of the proxy results in the same decision. Our methods provide a framework for testing other surrogate approaches used in conservation decision-making and risk assessment. © 2013 John Wiley & Sons Ltd.

Tough decisions: Reproductive timing and output vary with individuals' physiology, behavior and past success in a social opportunistic breeder

This article is part of a Special Issue SBN 2014. Photoperiod and the hormonal response it triggers are key determinants of reproductive timing in birds. However, other cues and physiological traits may permit flexibility in the timing of breeding and perhaps facilitate adaptation to global change. Opportunistic breeders are excellent models to study the adaptive significance of this flexibility, especially at the individual level. Here, we sought to quantify whether particular male physiological and behavioral traits were linked to reproductive timing and output in wild-derived zebra finches. We repeatedly assessed male stress-induced corticosterone levels (CORT), basal metabolic rate (BMR), and activity before releasing them into outdoor aviaries and quantifying each pair's breeding timing, investment, and output over a seven-month period. Despite unlimited access to food and water, the colony breeding activity occurred in waves, probably due to interpair social stimulations. Pairs adjusted their inter-clutch interval and clutch size to social and temperature cues, respectively, but only after successful breeding attempts, suggesting a facultative response to external cues. When these effects were controlled for statistically or experimentally, breeding intervals were repeatable within individuals across reproductive attempts. In addition, males' first laying date and total offspring production varied with complex interactions between pre-breeding CORT, BMR and activity levels. These results suggest that no one trait is under selection but that, instead, correlational selection acts on hormone levels, metabolism, and behavior. Together our results suggest that studying inter-individual variation in breeding strategy and their multiple physiological and behavioral underpinnings may greatly improve our understanding of the mechanisms underlying the evolution of breeding decisions.

How do homeopaths reason and make decisions? Integrating theory, practice, and education

BACKGROUND: Homeopathy is a major modality in complementary and alternative medicine. Significant tensions exist between homeopathic practice and education, evident in the diversity of practice styles and pedagogic models. Utilizing clinical reasoning knowledge in conventional medicine and allied health sciences, this article seeks to identify and critique existing research in this important area. MATERIALS AND METHODS: A literature search utilizing MEDLINE,(®) Allied and Complementary Medicine (AMED), and CINAHL(®) (Cumulative Index to Nursing and Allied Health Literature) was conducted. Key terms including clinical thinking, clinical reasoning, decision-making, homeopathy, and complementary medicine were utilized. A critical appraisal of the evidence was undertaken. RESULTS: Four (4) studies have examined homeopathic clinical reasoning. Two (2) studies sought to measure and quantify homeopathic reasoning. One (1) study proposed a reasoning model, based on pattern recognition, hypothetico-deductive reasoning, intuition, and remedy-matching (PHIR-M), resembling much that has been previously mapped in conventional medical reasoning research. The fourth closely investigated the meaning and use of intuition in homeopathic decision-making. CONCLUSIONS: Taken together, these four studies provide valuable insight into what is currently known about homeopathic clinical reasoning. However, despite the history and breadth of practice, little is known about homeopathic clinical reasoning and decision-making. Building on the research would require viewing clinical reasoning not only as a cognitive phenomenon but also as a situated and interactive one. Further research into homeopathic clinical reasoning is indicated.

From Smart Meters To Smart Decisions: Web-Based Support For The Water Efficient Household

Smart water metering technologies for residential buildings offer, in principle, great opportunities for sustainable urban water management. However, much of this potential is as yet unrealized. Despite that several ICT solutions have already been deployed aiming at optimum operations on the water utilities side (e.g. real time control for water networks, dynamic pump scheduling etc.), little work has been done to date on the consumer side. This paper presents a web-based platform targeting primarily the household end user. The platform enables consumers to monitor, on a real-time basis, the water demand of their household, providing feedback not only on the total water consumption and relevant costs but also on the efficiency (or otherwise) of specific indoor and outdoor uses. Targeting the reduction of consumption, the provided feedback is combined with notifications about possible leakages\bursts, and customised suggestions to improve the efficiency of existing household uses. It also enables various comparisons, with past consumption or even with that of similar households, aiming to motivate further the householder to become an active player in the water efficiency challenge. The issue of enhancing the platform’s functionality with energy timeseries is also discussed in view of recent advances in smart metering and the concept of “smart cities”. The paper presents a prototype of this web-based application and critically discusses first testing results and insights. It also presents the way in which the platform communicates with central databases, at the water utility level. It is suggested that such developments are closing the gap between technology availability and usefulness to end users and could help both the uptake of smart metering and awareness raising leading, potentially, to significant reductions of urban water consumption. The work has received funding from the European Union FP7 Programme through the iWIDGET Project, under grant agreement no318272.

Trade or investment? location decisions under regional integration

This paper studies the production and trade patterns that may arise between two different countries if plant location is introduced as a first step in the producers' decision making. A three-stage game is used: the first deals with location and the next two with capacity and final sales decisions. Demand and cost structures differ by country, and the latter contain specific elements related to the foreign operation. The structure of possible Nash-equilibria is examined and an analysis of the changes in the solution, if the countries engage in an integration process, is made. As in previous models, though global welfare gains may not be very high, single country ones may be considerable, due to changes in the location of the plants. However, even if full integration takes place, global Marshallian welfare may decrease. Conditions which determine a tendency towards multinationalisation are obtained. Assuming a move toward integration, conditions are also provided to characterize when exporting will be preferred to local production. The fact that producers may retain a certain discriminating power, notwithstanding the elimination of barriers to arbitrage, creates a tendency to locate production in the country where prices are higher. This explains why welfare gains may not be obvious. An empirical illustration, with real data from two MERCOSUL countries (Brazil and Argentina) illustrates the possible outcomes.

Testing the optimality of aggregate consumption decisions: is there rule-of-thumb behavior?

Consumption is an important macroeconomic aggregate, being about 70% of GNP. Finding sub-optimal behavior in consumption decisions casts a serious doubt on whether optimizing behavior is applicable on an economy-wide scale, which, in turn, challenge whether it is applicable at all. This paper has several contributions to the literature on consumption optimality. First, we provide a new result on the basic rule-of-thumb regression, showing that it is observational equivalent to the one obtained in a well known optimizing real-business-cycle model. Second, for rule-of-thumb tests based on the Asset-Pricing Equation, we show that the omission of the higher-order term in the log-linear approximation yields inconsistent estimates when lagged observables are used as instruments. However, these are exactly the instruments that have been traditionally used in this literature. Third, we show that nonlinear estimation of a system of N Asset-Pricing Equations can be done efficiently even if the number of asset returns (N) is high vis-a-vis the number of time-series observations (T). We argue that efficiency can be restored by aggregating returns into a single measure that fully captures intertemporal substitution. Indeed, we show that there is no reason why return aggregation cannot be performed in the nonlinear setting of the Pricing Equation, since the latter is a linear function of individual returns. This forms the basis of a new test of rule-of-thumb behavior, which can be viewed as testing for the importance of rule-of-thumb consumers when the optimizing agent holds an equally-weighted portfolio or a weighted portfolio of traded assets. Using our setup, we find no signs of either rule-of-thumb behavior for U.S. consumers or of habit-formation in consumption decisions in econometric tests. Indeed, we show that the simple representative agent model with a CRRA utility is able to explain the time series data on consumption and aggregate returns. There, the intertemporal discount factor is significant and ranges from 0.956 to 0.969 while the relative risk-aversion coefficient is precisely estimated ranging from 0.829 to 1.126. There is no evidence of rejection in over-identifying-restriction tests.