In Japan, where a prominent gap exists in what is considered a patient’s best interest between the medical and patient sides, appropriate decision-making can be difficult to achieve. In Japanese clinical settings, decision-making is considered an act of choice-making from multiple potential options. With many ethical dilemmas still remaining, establishing an appropriate decision-making process is an urgent task in modern Japanese healthcare. This paper examines ethical issues related to shared decision-making (SDM) in clinical settings in modern Japan from the psychocultural-social (...) perspective and discusses the ideal decision-making process in present Japan. Specifically, we discuss how five psychocultural-social tendencies – “surmise (Sontaku),” “self-restraint (Jishuku),” “air (atmosphere or mood, Kuuki),” “peer pressure (or tuning pressure, Docho-Atsuryoku),” and “community (Seken)”—which have often been referred to as characteristics of present-day Japanese people, may affect the ideal practice of SDM in Japanese clinical settings. We conclude that health care professionals must be aware of the possible adverse effects of the above Japanese psychocultural-social tendencies on the implementation of SDM and attempt to promote autonomous decision-making, thereby allowing patients to make treatment choices that sufficiently reflect their individual and personal views of life, experiences, goals, preferences, and values. (shrink)

Background Evidence concerning how Japanese physicians think and behave in specific clinical situations that involve withholding or withdrawal of medical interventions for end-of-life or frail elderly patients is yet insufficient. Methods To analyze decisions and actions concerning the withholding/withdrawal of life-support care by Japanese physicians, we conducted cross-sectional web-based internet survey presenting three scenarios involving an elderly comatose patient following a severe stroke. Volunteer physicians were recruited for the survey through mailing lists and medical journals. The respondents answered questions concerning (...) attitudes and behaviors regarding decision-making for the withholding/withdrawal of life-support care, namely, the initiation/withdrawal of tube feeding and respirator attachment. Results Of the 304 responses analyzed, a majority felt that tube feeding should be initiated in these scenarios. Only 18% felt that a respirator should be attached when the patient had severe pneumonia and respiratory failure. Over half the respondents felt that tube feeding should not be withdrawn when the coma extended beyond 6 months. Only 11% responded that they actually withdrew tube feeding. Half the respondents perceived tube feeding in such a patient as a "life-sustaining treatment," whereas the other half disagreed. Physicians seeking clinical ethics consultation supported the withdrawal of tube feeding (OR, 6.4; 95% CI, 2.5–16.3; P < 0.001). Conclusion Physicians tend to harbor greater negative attitudes toward the withdrawal of life-support care than its withholding. On the other hand, they favor withholding invasive life-sustaining treatments such as the attachment of a respirator over less invasive and long-term treatments such as tube feeding. Discrepancies were demonstrated between attitudes and actual behaviors. Physicians may need systematic support for appropriate decision-making for end-of-life care. (shrink)

Variation in decision-making about end-of-life care among ethnic groups creates clinical conflicts. In order to understand changes in preferences for end-of-life care among Japanese who immigrate to the United States, we conducted 18 focus groups with 122 participants: 65 English-speaking Japanese Americans, 29 Japanese-speaking Japanese Americans and 28 Japanese living in Japan.Negative feelings toward living in adverse health states and receiving life-sustaining treatment in such states permeated all three groups. Fear of being meiwaku, a physical, psychological or financial caregiving burden (...) on loved ones, was a prominent concern. They preferred to die pokkuri (popping off) before they become end stage or physically frail. All groups preferred group-oriented decision-making with family. Although advance directives were generally accepted, Japanese participants saw written directives as intrusive whereas Japanese Americans viewed them mainly as tools to reduce conflict created by dying person's wishes and a family's kazoku no jo– responsibility to sustain the dying patient. These findings suggest that in the United States Japanese cultural values concerning end-of-life care and decision-making process are largely preserved. (shrink)

Kojin Karatani wrote the essays in _History and Repetition_ during a time of radical historical change, triggered by the collapse of the Cold War and the death of the Showa emperor in 1989. Reading Karl Marx in an original way, Karatani developed a theory of history based on the repetitive cycle of crises attending the expansion and transformation of capital. His work led to a rigorous analysis of political, economic, and literary forms of representation that recast historical events as a (...) series of repeated forms forged in the transitional moments of global capitalism. _History and Repetition_ cemented Karatani's reputation as one of Japan's premier thinkers, capable of traversing the fields of philosophy, political economy, history, and literature in his work. The first complete translation of _History and Repetition_ into English, undertaken with the cooperation of Karatani himself, this volume opens with his innovative reading of _The Eighteenth Brumaire of Louis Bonaparte_, tracing Marx's early theoretical formulation of the state. Karatani follows with a study of violent crises as they recur after major transitions of power, developing his theory of historical repetition and introducing a groundbreaking interpretation of fascism as the spectral return of the absolutist monarch in the midst of a crisis of representative democracy. For Karatani, fascism represents the most violent materialization of the repetitive mechanism of history. Yet he also seeks out singularities that operate outside the brutal inevitability of historical repetition, whether represented in literature or, more precisely, in the process of literature's demise. Closely reading the works of Oe Kenzaburo, Mishima Yukio, Nakagami Kenji, and Murakami Haruki, Karatani compares the recurrent and universal with the singular and unrepeatable, while advancing a compelling theory of the decline of modern literature. Merging theoretical arguments with a concrete analysis of cultural and intellectual history, Karatani's essays encapsulate a brilliant, multidisciplinary perspective on world history. (shrink)

This paper describes an automatic monitoring system that constantly checks partial update in Web pages and notifies them to a user. While one of the most important advantages of the WWW is update of Web pages, we need to constantly check them out and this task takes much cognitive load. Thus applications to automatically check update of Web pages have been developed, however they can not deal with partial update like update in a particular cell in a table in a (...) Web page. Hence we developed a automatic monitoring system that checks such partial update. A user can give a system regions in which he/she wants to know the update in a Web page as training examples, and it is able to learn rules to identify the partial update by classification learning. By this learning, a user do not need to directly describe the rules. We implemented our system and some executed examples were presented. (shrink)

In this paper, we develop an organization method of page information agents for adaptive interface between a user and a Web search engine. Though a Web search engine indicates a hit list of Web pages to user’s query using a large database, they includes many useless ones. Thus a user has to select useful Web pages from them with page information indicated on the hit list, and actually fetch the Web page for investigating the relevance. Unfortunately, since the page information (...) on a hit list is neither sufficient nor necessary for a user, the adequate information is necessary for valid selection. However which information is adequate depends on a user and a task. Hence we propose adaptive interface AOAI in which different page information agents are organized through man-machine interaction. In AOAI, the page information agents indicating different page information on a hit list like the file-size, network traffic and a page title are prepared at first. A user evaluates them through searching with a search engine, and the agents are organized based on the evaluation. As results, different organizations are achieved depending on a user and a task. Finally we make experiments with subjects and find out AOAI is promising for adaptive interface between a user and a search engine. (shrink)

Approximately one in two hundred persons in the Marshall Islands have active tuberculosis. We examine the historical antecedents of this situation in order to assign ethical responsibility for the present situation. Examining the antecedents in terms of Galtung’s dialectic of personal versus structural violence, we can identify instances in the history of the Marshall Islands when individual subjects made decisions with large-scale ecologic, social, and health consequences. The roles of medical experimenters, military commanders, captains of the weapons industry in particular, (...) and industrial capitalism in general are examined. In that, together with Lewontin, we also identify industrial capitalism as the cause of tuberculosis, we note that the distinction between personal versus structural violence is difficult to maintain. By identifying the cause of the tuberculosis in the Marshall Islands, we also identify what needs be done to treat and prevent it. (shrink)

Anthropomorphic agents used in online-shopping need to be trusted by users so that users feel comfortable buying products. In this paper, we propose a model for designing trustworthy agents by assuming two factors of trust, that is, emotion and knowledgeableness perceived. Our hypothesis is that when a user feels happy and perceives an agent as being highly knowledgeable, a high level of trust results between the user and agent. We conducted four experiments with participants to verify this hypothesis by preparing (...) transition operators utilizing emotional contagion and knowledgeable utterances. As a result, we verified that users' internal states transitioned as expected and that the two factors significantly influenced their trust states. (shrink)

This paper considers the efficiency of the political market in the California State legislature. I analyzed the property tax limitation voter initiative, Proposition 13. I found that districts which supported Proposition 13 more strongly were more likely to oppose the incumbents regardless of whether the incumbents had the different preferences for property taxes from their districts. I also studied how legislators voted on the bills adopted after the passage of Proposition 13 to finance local governments. I found that legislators tended (...) to follow the constituents tax-cutting message expressed by the passage of Proposition 13. (shrink)

This paper considers a monthly pattern in government spending. I have found that public spending increases at the end of the fiscal year for both the Japanese central government and the US federal government and that the effects are stronger in recent years than in the past. I then propose two hypotheses that would explain why public spending increases at the end of the fiscal year.

This paper explores preferences and attitudes related to fiscal federalism held by the ASEAN people in the context of environmental issues. Fiscal federalism would predict that local environmental problems will be handled more efficiently by local governments, while national environmental problems will be solved more efficiently by the national government. But it is not obvious whether citizens consider in the same way as economics theory predicts. To unveil this point, I address questions of whether those who have higher consciousness toward (...) environmental issues at the neighbor or local level prefer local governments to decide environment policies, whether those who have more consciousness about environmental issues at the national level prefer the national government to decide the policies, and whether those who have higher consciousness toward environmental problems at global level prefer higher levels government such as the United Nations to decide the policies. By fitting multi-level probit regressions to cross-national survey data collected in ASEAN countries, I found the results supporting the hypotheses. The country analyses show the results which support the hypotheses in Brunei, Indonesia, and the Philippines. (shrink)

We propose an AI-assisted design concept exploration tool, the “Character Space Construction”. Concept designers explore and articulate the target product aesthetics and semantics in language, which is expressed using “Design Concept Phrases”, that is, compound adjective phrases, and contrasting terms that convey what are not their target design concepts. Designers often utilize this dichotomy technique to communicate the nature of their aesthetic and semantic design concepts with stakeholders, especially in an early design development phase. The CSC assists this designers' cognitive (...) activity by constructing a “Character Space”, which is a semantic quadrant system, in a structured manner. A CS created by designers with the assistance of the CSC enables them to discern and explain their design concepts in contrast with opposing terms. These terms in a CS are retrieved and combined in the CSC by using a knowledge graph. The CSC presents terms and phrases as lists of candidates to users from which users will choose in order to define the target design concept, which is then visualized in a CS. The participants in our experiment, who were in the “arts and design” profession, were given two conditions under which to create DCPs and explain them. One group created and explained the DCPs with the assistance of the proposed CSC, and the other did the same task without this assistance, given the freedom to use any publicly available web search tools instead. The result showed that the group assisted by the CSC indicated their tasks were supported significantly better, especially in exploration, as measured by the Creativity Support Index. (shrink)

Today's computers are becoming ever more versatile. They are used in various applications, such as for education, entertainment, and information services. In other words, computers are often required to not only inform users of information but also communicate with them socially. Previous studies explored the design of ambient light displays and suggested that such systems can convey information to people in the periphery of their attention without distracting them from their primary work. However, they mainly focused on using ambient lights (...) to convey certain information. It is still unclear whether and how the lights can influence people's perception and decision-making. To explore this, we performed three experiments using a ping-pong game, Ultimatum game, and Give-Some game, in which we attached an LED strip to the front-bottom of a computer monitor and had it display a set of light expressions. Our evaluation of the results suggested that expressive lights do affect human perception and decision-making. Participants liked and anthropomorphized the computer more when it displayed light animations. Particularly, they perceived the computer as positive and friendlier when it displayed green and low intensity light animation, while red and high intensity light animation was perceived as negative and more hostile. They consequently behaved with more tolerance and cooperation to the computer when it was positive compared with when it was negative. The findings can open up possibilities for the design of ambient light systems for various applications where human-machine interaction is needed. (shrink)

Specificities of enzymes involved in plant specialized metabolism, including flavonoid biosynthesis, are generally promiscuous. This enzyme promiscuity has served as an evolutionary basis for new enzyme functions and metabolic pathways in land plants adapting to environmental challenges. This phenomenon may lead, however, to inefficiency in specialized metabolism and adversely affect metabolite‐mediated plant survival. How plants manage enzyme promiscuity for efficient specialized metabolism is, thus, an open question. Recent studies of flavonoid biosynthesis addressing this issue have revealed a conserved strategy, namely, (...) a homolog of chalcone isomerase with no catalytic activity binds to chalcone synthase, a key flavonoid pathway enzyme, to narrow (or rectify) the enzyme's highly promiscuous product specificity. Reducing promiscuity via specific protein–protein interactions among metabolic enzymes and proteins may be a solution adopted by land plants to achieve efficient operation of specialized metabolism, while the intrinsic promiscuity of enzymes has likely been retained incidentally. (shrink)

In this paper, we propose a Future View system that assists user's usual Web browsing. The Future View will prefetch Web pages based on user's browsing strategies and present them to a user in order to assist Web browsing. To learn user's browsing strategy, the Future View uses two types of learning classifier systems: a content-based classifier system for contents change patterns and an action-based classifier system for user's action patterns. The results of learning is applied to crawling by Web (...) robots, and the gathered Web pages are presented to a user through a Web browser interface. We experimentally show effectiveness of navigation using the Future View. (shrink)

In this paper, we propose a framework for searching information through both the WWW and a human group. Though information retrieval using a searc engine in the WWW is very useful, we can not acquire local information owned by persons and not explicitly described in text. A user knows neither where target information is in the WWW nor who knows in a human group. Thus we integrate the information retrieval in the WWW with that in a human group, develop a (...) heterogeneous information search system HERIS as a multi-agent system. We develop this framework as multi-agent system consisting of user agents and search engine agents, and use contract net protocol to communication among the agents. A user agent and a search engine agent are assigned to a user and a search engine. Each of the agents maintains a user profile and a search engine profile. When a user gives a query to a system, it selectively searches information resources consisting the WWW and user group. Finally a user acquires integrated results of a hit list from the WWW and a audio/video connection to a user who can answer the query. It was found through experimental evaluation that information retrieval using a human group as an information resource is valid and a search with HERIS has a different character from conventional search engines. (shrink)

Empirical surveys about medical futility are scarce relative to its theoretical assumptions. We aimed to evaluate the difference of attitudes between laypeople and physicians towards the issue. A questionnaire survey was designed. Japanese laypeople (via Internet) and physicians with various specialties (via paper-and-pencil questionnaire) were asked about whether they would provide potentially futile treatments for end-of-life patients in vignettes, important factors for judging a certain treatment futile, and threshold of quantitative futility which reflects the numerical probability that an act will (...) produce the desired physiological effect. Also, the physicians were asked about their practical frequency and important reasons for futile treatments. 1134 laypeople and 401 (80%) physicians responded. In all vignettes, the laypeople were more affirmative in providing treatments in question significantly. As the factors for judging futility, medical information and quality of life (QOL) of the patient were rather stressed by the physicians. Treatment wish of the family of the patient and psychological impact on patient side due to the treatment were rather stressed by laypeople. There were wide variations in the threshold of judging quantitative futility in both groups. 88.3% of the physicians had practical experience of providing futile treatment. Important reasons for it were communication problem with patient side and lack of systems regarding futility or foregoing such treatment. Laypeople are more supportive of providing potentially futile treatments than physicians. The difference is explained by the importance of medical information, the patient family’s influence to decision-making and QOL of the patient. The threshold of qualitative futility is suggested to be arbitrary. (shrink)