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Civil Liability of Medical Institution
No full text 隨著社會的變遷，近年來，醫療糾紛成為我國醫、法二界共同關注的焦點。觀察目前醫療糾紛之發展，可以發現各界多將爭論重點集中於第一線醫療人員，扮演醫療服務提供核心角色的醫療機構卻在眾多案件中隱而未現。但在許多情況，問題的根源毋寧在於醫療機構之本身，因此實有對醫療機構民事責任加以深入探討之必要。
本文從英美法之比較發覺，不論在僱用人之代負責任亦或組織責任上，其實務與學說見解都深受法政策之影響，意即其乃受到醫療機構地位轉變之影響應運而生的責任體系。在代負責任之部分，醫療機構的責任係從無到有，從嚴格到寬泛之進程，然而因為代負責任有受僱人成立侵權行為之前提要件，因此無法全盤解決醫療實務上所面臨的問題，司法實務遂以醫療機構為主體，課與其組織責任，以填補其法體系之不足，並藉此而力求達成正確填補損害以及預防未來損害、創建安全醫療系統之目標。
而後本文回到我國司法體系，觀察醫療機構責任架構，並分就僱用人責任、組織責任、契約責任以及消費者保護法責任進行探討。本文認為，於我國民事法體系下，無論是僱用人責任、依民法第二十八條成立之法人侵權責任亦或依民法第二二四條成立之契約責任，皆須以自然人之故意過失為前提始能要求醫療機構負責，然而觀察目前之醫療糾紛，許多醫療事故之產生實係出自於系統性之錯誤而非個人性之錯誤，此時若係因原告無法找到故意過失之自然人，即將不幸之苦果交由被害人承擔，毋寧是一種不當的責任分配方式。再者，由於民事責任成立之前提係自然人之故意過失，因此有時法院在別無選擇的狀態下，為轉移被害人之損害，亦會不當的課與不應承擔責任之醫療機構人員或代表人民事責任，藉此與醫療機構責任勾稽，此種作法實為飲鴆止渴，不得其利反生其害。
為解決醫療糾紛在現今民事法體系下之困境，本文參酌外國立法例及學說認為，僅管法人在真實世界中僅管無法實際「自為行為」，然而外國立法例與學說毋寧是將法人機構上所呈現出來之「組織狀態」擬制為法人之行為，就此，關於目前學說實務認為法人無法直接該當侵權行為之疑慮即可解決。蓋法人本來即為法律之創造物，與一般民事法體系本有扞格，因此重點並非法人可否為自為行為，而是如何找出一套可行之責任歸屬理論以解決民事責任法之需求。本文認為，在吾人肯認醫療機構組織責任建立之必要時，本文所提出之責任歸屬模式應可作為解釋適用之依據，而此種責任係因法人之組織狀態而來，因此稱之為組織責任。在確認醫療機構可以自為行為而直接成立侵權責任後，本文分就提供安全設備場所之義務、檢驗結果通知義務、應召會診之義務、完善人力配置之義務、管控院內感染之義務以及建立整體安全系統之義務等面向加以說明，批判我國目前司法實務見解之不足，並以醫療機構組織責任之觀點出發來建構不同的論理方式。而就契約責任之部分，本文認為法人侵權責任之突破亦同樣可運用於契約責任上，意即穿透以自然人故意過失為歸責前提之窠臼，直接以醫療機構為主體來論斷契約責任。而後本文特別以組織管理之概念來探討醫療機構之主給付義務、從給付義務及附隨義務之義務內容。
此外，本文認為消保法之無過失責任並不可採，而藉由組織責任之提出，可以達成提倡消保責任者所欲達成之目的，亦不會使醫療機構背負過重之責任，應係一種務實之責任類型。
本篇論文之提出，最主要係要解決目前醫療糾紛實務上所遇到的困境，而藉由僱用人責任之重新梳理、組織責任之之全面建立與契約責任之再構築，相信將可解決目前醫療實務許多問題。最後，本論文由衷希望，經由本篇論文所提出來的觀點，能適度緩解目前過度緊繃的醫病關係，創立更為安全之醫療環境。 With the rapid change of social development, the role of medical institutions as health-care providers has evolved significantly over the past decades. Many studies found that today’s medical institutions are directly implicating in most of harmful medical errors; however, medical malpractice litigations and its doctrinal substructure are still heavily oriented toward holding individuals liable for medical injuries, and doctrines that contemplate the role of organizations still gain little attention. In order to conform the increased role of medical institutions, Taiwan’s legal system needs to figure out civil liability of theabovementioned as central providers of health care.
In American and British laws, hospital can be held liable under either of two theories, vicarious liability and corporate liability, which were both heavily affected by the changing status of hospitals. Vicarious liability is based on Respondeat Superior whereby the hospital’s liability is answerable for those torts committed by its employees; therefore, it cannot solve the disputes creating from the fault of organization. Thus, there is no negligence of individual members. Anglo-American law creates “corporate liability” to deal with organizational or system failures, thus improving patient safety to fill this gap in medical malpractice,
Taiwan’s legal system lacks similar concepts to solve the same problems. No matter Civil Code Article 188, Article 28 or Article 244, they all focus on negligence of nature person, and ignore the importance of medical institutions.
To deal with medical malpractice, the author believes that the most important question is what kind of view better serves justice. The doctrine of corporate liability imposes upon medical institution an independent, affirmative, and non-delegable duty to provide quality medical care. Therefore, an injured party does not have to rely on and establish the negligence of a third party. Thus, the plaintiffs do not need to find out the wrongdoers except the medical institution itself; namely, the imposition of corporate liability provides an easier source of compensation for the injured compliant. Furthermore, the threat of corporate liability is a useful and positive tool that gives medical institutions great incentives for self-monitoring and diligent, careful operation. After embracing the doctrine of corporate liability, the author discusses different duties of medical institution and breach of these duties. In addition,, the author also borrows this tort concept to apply to contract liability of medical institutions, thus establishing comprehensive protection of patient safety.
The current conflicts between patients and doctors have led to a rethinking of the relations between Taiwan’s health care and civil justice systems. This is the time to renovate our system of liability to design it better suit a new world dominated by medical institutions. The “corporate liability” model the author has introduced and developed is precisely constructed for this purpose
Relation between the Fluorescence and Shade of Extracted Human Teeth
No full text紫外光照射下，自然牙會呈現淡藍色之螢光，此性質使牙齒看起來更亮白，故製做補綴物時亦需考慮此特性，始可於不同光線環境下看起來擬真自然，故了解自然牙之螢光性質對於製作美觀之復形體非常重要。牙科復形材料如樹脂與瓷粉，亦常添加螢光劑以模擬自然牙螢光效果，文獻上大多數學者支持有機物質造成螢光，亦有作者對於螢光、年齡、性別與齒位之相關性進行比較，但對於明確之螢光物質與發光機制卻不清楚，亦無螢光反應對於牙齒呈色影響之研究。為能對於自然牙螢光性質進一步了解，以幫助牙科臨床上進行良好之比色，於製作補綴物時達到更擬真之效果，我們利用螢光光譜儀測量人類拔下之自然牙樣本之螢光，並使用數位比色儀記錄其CIE (Commision International De L’eclairage)色度，將所獲得資料進行分析比較。研究目的專注於確認自然牙螢光機制，辨別自然牙不同部位之螢光差異，測量自然牙螢光光譜並比較其與性別、年齡、齒位之關係，並將光譜與臨床比色結果互為對照。
從43位拔牙病人中收集65顆牙齒樣本，並記錄病人之年齡、性別、齒位等資料。其中5顆牙經切片後分別測量以400℃加熱除去有機質、以EDTA(ethylenediaminetetraacetic acid)溶液脫鈣後測取螢光並與原始螢光進行比較。另外60顆牙齒以高速磨牙手機各取下4×4×2 mm大小之樣本，將樣本置入校正過之光激發光譜儀內，分別從牙釉質面與牙本質面進行激發光譜與放射光譜之測量與記錄，計算每一樣本螢光之CIE光度座標。另使用牙科臨床適用之數位比色儀測
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量每一樣本CIE L*a*b*色度座標，將螢光光譜儀與數位比色儀所測得之資料互相比較。
實驗結果與結論：(一)自然牙樣本螢光因為高溫破壞而消失，然而隨脫鈣時間增加，螢光表現加強，因此推論有機螢光物質應為自然牙螢光之成因。(二)於同一顆牙齒之切塊，牙本質面之螢光強度遠大於牙釉質面之螢光強度。(三)自然牙樣本其激發光譜大約介於波長300 nm至450 nm之間，激發波峰約為390 nm；放射光譜大約介於波長410 nm至600 nm之間，放射波峰約為470 nm，不同個體之間其光譜會有個別差異。(四)自然牙螢光之CIE座標值於藍光至藍綠光範圍。(五)源自同一個體之自然牙樣本其光譜結構與光譜顏色之CIE座標相似但其螢光強度不同。(六)將螢光強度與CIE Lab以複迴歸比較，自然牙波峰螢光強度與色度座標中之b值呈現負相關並達統計上顯著，即螢光強度越強，色度座標越偏向藍光。(七)色胺酸之螢光其激發光譜介於紫外光至370 nm之間，激發波峰約為300 nm；放射光譜大約介於波長370 nm至550 nm之間，放射波峰約為380 nm，CIE色度座標為藍紫光。因與自然牙螢光光譜不相似，推測色胺酸不是自然牙中之螢光物質。The natural teeth emit blue fluorescence under the exposure to ultraviolet. It is essential that dental prostheses present such fluorescent character to be as vivid as natural teeth even thought under special light source. Therefore, some chemical activators were added to commercial dental restorative material or porcelains to mimic the fluorescence of natural teeth. Several researchers concluded that organic luminophore may be the possible candidates of dental fluorescence. Furthermore, a few studies demonstrated fluoresce intensity was age-dependent and the sex and the type of tooth have no significant influence on tooth fluorescence. The mechanism of fluorescence of natural teeth, however, was not yet clear. Very few attempts have been made in exploring the relationship between fluorescence and tooth color. Since understanding the fluorescence may improve the esthetics of dental prostheses, we measured the fluorescent spectra of extracted human teeth and recorded the CIE coordinates of tooth color. The purposes of this study were to explore the mechanics of fluorescence of natural teeth, to correlate the fluorescent spectra of a natural tooth with the donor’s sex and age and the type of tooth, and to analyze if there is any correlation between fluorescence
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and tooth shade.
Sixty-five extracted human teeth from 43 patients were collected and the sex, age of the patient and type of tooth were also recorded. Five of the samples were sectioned and then separately processed with 400℃ heat to denature the organic compound of teeth or soaked in EDTA solution to demineralize the teeth. The fluorescent spectra of the original and treated samples were measured. Otherwise, a specimen with a size of 4×4×2 mm was cut from each of the other 60 natural teeth by means of high speed dental hand piece. The excitation and emission spectra were obtained from the enamel side and the dentin side using corrected PL spectrophotometer. The CIE coordinates (X, Y) of each sample were also computed. In addition, the CIE L*a*b* color scales were measured with a colorimeter and compared with fluorescence intensity.
Experimental results and conclusion：(1) The fluorescene of a tooth was diminished with heat and increased with demineralization, which suggested that organic luminophore could be the candidates of fluorescence. (2) The fluorescence of dentin is much stronger than enamel in a tooth. (3) The wavelength of the excitation spectra of extracted human teeth was around 300 nm to 450 nm with peak at 390 nm, as well as the wavelength of the emission spectra of extracted human teeth was
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around 410 nm to 600 nm with peak at 470 nm. There was inter-individual difference in fluorescence spectra and intensity. (4) The X and Y values of tristimulus calculated from the spectra located in blue to greenish-blue region in the CIE color space. (5) Different teeth from the same individual showed spectra with similar peak wavelength and CIE coordinates but different fluorescent intensity. (6) Regarding to the correlation between fluorescence and L*a*b* color scale, the peak intensity of fluorescence was statistically negatively correlated to the b value. It meant that a higher fluorescence intensity was accompanied with a higher blue tone in a tooth. (7) The wavelength of the excitation spectra of tryptophan, a suggested candidate of fluorescence, was around short wavele UV light to 370 nm with peak at 300 nm, and the wavelength of the emission spectra was around 370 nm to 550 nm with peak at 380 nm. The fluorescence of tryptophan located in purple-blue area. As a result, the tryptophan may not a possible candidate of the fluorescence
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
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