自杀和生命的意义——来自脑科学研究的解读

生命本身是一个随机事件,并不具有高尚的意义。进化的结果使人类可通过工作、家庭和人际关系等给予自己的生命以意义感。当我们的生活方式使脑内奖赏系统获得刺激,就会带来生命具有意义的感受,这种感受给人带来更好的生存机会。生存的欲望是一切生物体最具特征的属性,一些精神疾病患者缺乏这种欲望。自杀主要发生于精神疾病患者,它并非是基于自由意志的行为。抗精神病治疗和适当的社会交往可以预防自杀。由于不同个体有着不同的大脑,人们的生活方式就应该去适应各自大脑的特征。只要人们的生活方式不对他人造成过多的伤害,政府就应该允许和保护人们自由地按照各自的方式生活。     

New Organizational Forms for Competing in Highly Dynamic Environments: the Network Paradigm

Turbulence and rapid change in the business environment have been associated for some time with the development of new network organizational forms which put various types of strategic alliance and other inter-organizational collaborations into effect. This paper traces the rationale for the formation of such networks and the associated vertical disaggregation of functions and implications for internal organizational design. This leads to the proposal of a classification framework for network forms. Using the dimensions of volatility of environmental change on the one hand, and the type of inter-organizational relationship involved (collaborative or transactional) on the other hand, network forms are classified as: hollow networks, flexible networks, value-added networks and virtual networks. In each case it is possible to identify the environmental and organizational contingencies most likely to be associated with the emergence and adoption of a particular type of network arrangement. This argument leads to the identification of a new research agenda which has the goals of developing more robust conceptualizations of network characteristics; better understanding the contingencies surrounding the emergence of network forms and their relative efficiencies and specifying some of the major implications of network formation for internal organizational design. In parallel the paper identifies a number of managerial implications for setting strategic priorities and developing appropriate management systems in these new organizational contexts.     

Competitive Advantage, Quality Strategy and the Role of Marketing

The improvement of product and service quality has been widely discussed in the literature as an appropriate competitive strategy for achieving sustainable competitive advantage. However, neither the linkage between competitive strategy and quality, nor the role of marketing in the implementation of quality-based competitive strategy, has received detailed attention in the marketing and strategy literatures. This paper explores the interface between marketing and quality management in seller organizations, by developing a contingency model of quality strategy. This model is grounded in the literatures of marketing, strategy and quality management, and the perceptions of managers uncovered in exploratory interviews.     

IRS offers safe harbor in physician employment contracts

Last year, the Internal Revenue Service (IRS) issued Revenue Procedure 93-19 (Rev. Proc. 93-19), which provides guidelines regarding service and other contracts involving facilities financed with tax-exempt bonds. Rev. Proc. 93-19 creates four "safe harbors" for certain contracts signed by tax-exempt organizations that will not jeopardize the organizations' tax-exempt bond interest. Those guidelines and methods for complying with them are the subject of the following article. "Health Law" is a regular feature of Physician Executive contributed by Epstein Becker & Green. Mark Lutes of the law firm's Washington, D.C., offices serves as editor of the column.     

Delivery and funding are provincial matters in Canada

The following article is one of a series that deal with the provision of health care services around the world. Other countries in the series include Germany, Italy, Japan, Mexico, the Netherlands, and the United States. Countries scheduled for coverage in the series include Austria, France, Singapore, Spain, and the United Kingdom. The countries are described using a grid of characteristics so that comparisons may be made more easily. All of the analyses, along with further comparative data, will be gathered into a freestanding book to be published later in the year. Dr. Mendoza serves as editor for the project.     

Propagation of Uncertainty in Risk Assessments: The Need to Distinguish Between Uncertainty Due to Lack of Knowledge and Uncertainty Due to Variability

In quantitative uncertainty analysis, it is essential to define rigorously the endpoint or target of the assessment. Two distinctly different approaches using Monte Carlo methods are discussed: (1) the end point is a fixed but unknown value (e.g., the maximally exposed individual, the average individual, or a specific individual) or (2) the end point is an unknown distribution of values (e.g., the variability of exposures among unspecified individuals in the population). In the first case, values are sampled at random from distributions representing various "degrees of belief" about the unknown "fixed" values of the parameters to produce a distribution of model results. The distribution of model results represents a subjective confidence statement about the true but unknown assessment end point. The important input parameters are those that contribute most to the spread in the distribution of the model results. In the second case, Monte Carlo calculations are performed in two dimensions producing numerous alternative representations of the true but unknown distribution. These alternative distributions permit subject confidence statements to be made from two perspectives: (1) for the individual exposure occurring at a specified fractile of the distribution or (2) for the fractile of the distribution associated with a specified level of individual exposure. The relative importance of input parameters will depend on the fractile or exposure level of interest. The quantification of uncertainty for the simulation of a true but unknown distribution of values represents the state-of-the-art in assessment modeling.     

Sticks,stones and broken bones: Military law’s criteria for aggravated assault

In light of recent military court decisions, this article asks whether the Uniform Code of Military Justice should be revised to encompass batteries which do not satisfy the present nineteenth century definition of grievous bodily harm. In answering this question, the article first traces the evolution of the military law of battery. Current medical views on the consequences of a criminal attack, particularly the psychic effects of violence, are then explored, concluded with a discussion of the competing considerations which should affect any decision to change the law. He has also been a visiting Distinguished Professor of Law at the U.S. Military Academy and has written numerous articles on civil-military relations.