Journal articles on the topic 'Problème inverse'

We propose a novel mathematical algorithm to offer a solution for the inverse random dynamic force identification in practical engineering. Dealing with the random dynamic force identification problem using the proposed algorithm, an improved maximum entropy (IME) regularization technique is transformed into an unconstrained optimization problem, and a novel conjugate gradient (NCG) method was applied to solve the objective function, which was abbreviated as IME-NCG algorithm. The result of IME-NCG algorithm is compared with that of ME, ME-CG, ME-NCG, and IME-CG algorithm; it is found that IME-NCG algorithm is available for identifying the random dynamic force due to smaller root mean-square-error (RMSE), lower restoration time, and fewer iterative steps. Example of engineering application shows that L-curve method is introduced which is better than Generalized Cross Validation (GCV) method and is applied to select regularization parameter; thus the proposed algorithm can be helpful to alleviate the ill-conditioned problem in identification of dynamic force and to acquire an optimal solution of inverse problem in practical engineering.

On the basis of analyzing the transverse vibration of a clamped-free beam, in this paper an inverse problem is investigated. The analytical method· and computational program me have been presented for determination of the length of the beam when vibrations at some points on the beam with external distribution excitation or vibration at one point with some excited frequencies are measured. The obtained results from the illustration examples described in the paper give us the procedure for selecting one solution in multi-solution inverse problem.

Abstract Multi-energy computed tomography (ME-CT) is an x-ray transmission imaging technique that uses the energy dependence of x-ray photon attenuation to determine the elemental composition of an object of interest. Mathematically, forward ME-CT measurements are modeled by a nonlinear integral transform. In this paper, local conditions for global invertibility of the ME-CT transform are studied, and explicit stability estimates quantifying the error propagation from measurements to reconstructions are provided. Motivated from the inverse problem of image reconstruction in ME-CT, an iterative inversion algorithm for the so-called P-functions is proposed. Numerical simulations for ME-CT, in two and three materials settings with an equal number of energy measurements, confirm the theoretical predictions.

Nursing judgment is an essential component in the delivery of safe, quality patient care. Nurses must have the knowledge and skills to question authority, make judgments, substantiate evidence, and advocate for the patient. Traditional pedagogy in content-laden courses remains primarily lecture based. Incorporating active strategies to strengthen professional practice is essential. A pilot study assessed senior baccalaureate nursing students’ perceptions of problem-based learning (PBL) and their readiness for self-directed learning. In addition, the authors analyzed the relationship between readiness for self-directed learning and course content mastery using PBL. Students completed the Self-directed Learning Readiness Scale, the Problem-Based Learning Environment Inventory, and course content mastery exams. Students reported positive experiences with PBL and readiness for self-directed learning. Readiness for self-directed learning and 2 of 5 exam scores were inversely, significantly related. Students’ perceptions of their readiness for self-directed learning did not always correspond with course content mastery. Specifically, some students who perceived themselves as ready for self-directed learning did not perform well on course content exams. This inverse relationship has not been reported by other researchers and brings an interesting perspective to student perceptions and actual performance. Four themes emerged from students’ narrative responses: Prepared Me for Real Life Professional Situations, Stimulated My Critical Thinking, Promoted Independent Problem Solving, and Supported Learning Retention. PBL as a pedagogical approach provides opportunities for nursing students to explore their professional independence while attempting to master content.

Soil salinity is considered the most serious socio-economic and environmental problem in arid and semi-arid regions. This study was done to estimate the soil salinity and monitor the changes in an irrigated palm grove (42 ha) that produces dates of a high quality. Topsoil samples (45 points), were taken during two different periods (May and November), the electrical conductivity (EC) and Sodium Adsorption Ratio (SAR) were determined to assess the salinity of the soil. The results of the soil analysis were interpolated using two geostatistical methods: inverse distance weighting (IDW) and ordinary Kriging (OK). The efficiency and best model of these two methods was evaluated by calculating the mean error (ME) and root mean square error (RMSE), showing that the ME of both interpolation methods was satisfactory for EC (−0.003, 0.145) and for SAR (−0.03, −0.18), but the RMSE value was lower using the IDW with both data and periods. This can explain the accuracy of the IDW interpolation method. This model showed a dominance of soil salinity distribution in the South and South-East of the study area during the first season, and for the second season, the salts were concentrated in the middle of the area. Several factors could interact in this variation such as the topographic direction of the water flow and the aridity of the climate (evaporation). From this study emerges the need to maintain a better management of agricultural water and soils, avoiding salt accumulation, to ensure a good yield and the sustainability of agriculture in arid environments.

Despite some discomfort with this grandly philosophical topic, I do in fact hope to address a venerable pair of philosophical chestnuts: mathematical truth and existence. My plan is to set out three possible stands on these issues, for an exercise in compare and contrast. A word of warning, though, to philosophical purists (and perhaps of comfort to more mathematical readers): I will explore these philosophical positions with an eye to their interconnections with some concrete issues of set theoretic method.Let me begin with a brief look at what to count as ‘philosophy’. To some extent, this is a matter of usage, and mathematicians sometimes classify as ‘philosophical’ any considerations other than outright proofs. So, for example, discussions of the propriety of particular mathematical methods would fall under this heading: should we prefer analytic or synthetic approaches in geometry? Should elliptic functions be treated in terms of explicit representations (as in Weierstrass) or geometrically (as in Riemann)? Should we allow impredicative definitions? Should we restrict ourselves to a logic without bivalence or the law of the excluded middle? Also included in this category would be the trains of thought that shaped our central concepts: should a function always be defined by a formula? Should a group be required to have an inverse for every element? Should ideal divisors be defined contextually or explicitly, treated computationally or abstractly? In addition, there are more general questions concerning mathematical values, aims and goals: Should we strive for powerful theories or low-risk theories? How much stress should be placed on the fact or promise of physical applications? How important are interconnections between the various branches of mathematics? These philosophical questions of method naturally include several peculiar to set theory: should set theorists focus their efforts on drawing consequences for areas of interest to mathematicians outside mathematical logic? Should exploration of the standard axioms of ZFC be preferred to the exploration and exploitation of new axioms? How should axioms for set theory be chosen? What would a solution to the Continuum Problem look like?

AbstractWe introduce the problem of knot‐based inverse perceptual art. Given multiple target images and their corresponding viewing configurations, the objective is to find a 3D knot‐based tubular structure whose appearance resembles the target images when viewed from the specified viewing configurations. To solve this problem, we first design a differentiable rendering algorithm for rendering tubular knots embedded in 3D for arbitrary perspective camera configurations. Utilizing this differentiable rendering algorithm, we search over the space of knot configurations to find the ideal knot embedding. We represent the knot embeddings via homeomorphisms of the desired template knot, where the weights of an invertible neural network parametrize the homeomorphisms. Our approach is fully differentiable, making it possible to find the ideal 3D tubular structure for the desired perceptual art using gradient‐based optimization. We propose several loss functions that impose additional physical constraints, enforcing that the tube is free of self‐intersection, lies within a predefined region in space, satisfies the physical bending limits of the tube material, and the material cost is within a specified budget. We demonstrate through results that our knot representation is highly expressive and gives impressive results even for challenging target images in both single‐view and multiple‐view constraints. Through extensive ablation study, we show that each proposed loss function effectively ensures physical realizability. We construct a real‐world 3D‐printed object to demonstrate the practical utility of our approach.

Abstract This study addresses the problem of accurately assessing offshore wind resources and optimizing wind farm layouts along the Tamil Nadu coastline in India. The aim is to evaluate the efficacy of ERA5 reanalysis wind data at 100 m for offshore wind resource assessment and to determine the optimal layout for an offshore wind farm in Tamil Nadu's offshore subzone B1. Methods include a detailed comparison of ERA5 reanalysis wind data against empirical data from Tamil Nadu’s coastline, focusing on wind rose diagram generation for layout optimization. The research also involves a thorough financial analysis of wind energy projects, estimating capital and operational expenses, and calculating the levelized cost of energy (LCoE). Results reveal a slight underestimation of wind speed by ERA5 but confirm its overall efficacy in offshore wind resource assessments. The optimal wind farm layout is identified with a density of 5.17 MW per square kilometer and a turbine spacing of 7.22 me ters, aiming to maximize power generation and minimize array losses. The financial analysis estimates the LCoE at Rs. 8.84 per kWh. Additionally, the study finds an inverse relationship between the target LCoE and the required generation-based incentives (GBIs). Conclusions emphasize the necessity of substantial financial support for India's offshore wind industry. The study highlights the crucial role of policymakers in balancing costeffectiveness with long-term industrial growth to effectively foster the offshore wind energy sector. This research provides valuable insights into the techno-economic viability of offshore wind projects in India, serving as an essential decision-making tool for policymakers, project developers, and prospective investors in support of India's renewable energy goals.

Abstract Background Major depressive disorder (MDD) is a highly heterogeneous mental illness and a major public health problem worldwide. A large number of observational studies have demonstrated a clear association between MDD and coronary heart disease (CHD), and some studies have even suggested that the relationship is bidirectional. However, it was unknown whether any causal relationship existed between them and whether causality was bidirectional in such an instance. Thus, we aimed to determine whether there is a bidirectional causal relationship between major depressive disorders and coronary heart disease. Methods Our two-sample Bidirectional Mendelian Randomization Study consisted of two parts: forward MR analysis regarded MDD as exposure and CHD as the outcome, and reverse MR analysis considered CHD as exposure and MDD as the outcome. Summary data on MDD and CHD were obtained from the IEU Open GWAS database. After screening criteria(P < $$5\times {10}^{-8}$$ 5 × 10 - 8 ), 47 MDD-associated SNPs and 39 CHD-associated SNPs were identified. The inverse-variance weighted (IVW) method, ME-Egger regression, and weighted median method were used to estimate causality. In addition, sensitivity methods, including the heterogeneity test, horizontal pleiotropy test, and leave-one-out method, were applied to ensure the robustness of causal estimation. Results Based on the MR-Egger regression intercept test results, there did not appear to be any horizontal pleiotropy in this study (MDD: intercept = -0.0000376, P = 0.9996; CHD: intercept = -0.0002698, P = 0.920). Accordingly, IVW results suggested consistent estimates of causal effect values. The results showed that people with MDD increased the risk of CHD by 14.7% compared with those without MDD (OR = 1.147, 95%CI: 1.045–1.249, P = 0.009). But there was no direct evidence that CHD would increase the risk of MDD(OR = 1.008, 95%CI: 0.985–1.031, P = 0.490). The heterogeneity test and funnel plot showed no heterogeneity in 47 SNPs of MDD (Q = 42.28, $${I}^{2}$$ I 2 =0, P = 0.629), but there was heterogeneity in 39 SNPs of CHD (Q = 62.48, $${I}^{2}$$ I 2 =39.18%, P = 0.007). The leave-one-out method failed to identify instances where a single SNP was either biased toward or dependent on the causation. Conclusion Our study supports a one-way causal relationship between MDD and CHD, but there is no bidirectional causal relationship. MDD increases the risk of CHD, but there is no evidence that CHD increases the risk of MDD. Therefore, the influence of psychological factors should also be considered in the prevention and treatment of CHD. For MDD patients, it is necessary to prevent cardiovascular diseases.

Photograph by Gonzalo Echeverria (2010)Donald Crowhurst wanted to sail around the world. Or he wanted the world to believe he had sailed around it. Whilst the rest of the competitors in the 1968-9 Sunday Times Golden Globe Race sailed their wonky crafts through treacherous seas, Crowhurst dropped anchor in the quiet waters of the South Atlantic and falsified his logs. For artist Tacita Dean, who has made a number of works about Crowhurst (Disappearance at Sea, Teignmouth Electron): Crowhurst's problem was that he had an imagination. You can't have any imagination if you are going to sail around the world, otherwise you have doubt. Crowhurst had doubt, he imagined failure ... . I think it’s crucial to art as well that you somehow imagine failure. Doubt is very important (17). ** In developing this issue of M/C Journal we were interested in two related questions about doubt. On the one hand, we hoped to gather case studies that can give some indication of where and how doubt surfaces in contemporary media, culture and politics. We have collected a diverse sample of case studies considering the role of doubt in the American political response to 9/11 (Burns), the media’s reporting of sexual assault (Waterhouse-Watson), how scientists talk about climate change (Simpson) and the philosophy of religion (Brown). However, we were also interested in attracting articles that could contribute to our thinking about doubt as a method and mode of practice. Our feature article, by Sydney based artist and writer Ryszard Dabek presents both a case study, discussing Jean Luc Godard’s doubts about cinema through selected films from his oeuvre, while also demonstrating how a methodology of doubt can produce insightful cultural criticism. Elisabeth Hanscombe writes from a perspective that seeks to hold in tension the doubts that haunt interdisciplinary research (and the researcher) with the need to produce rigorous research outcomes. David Macarthur has written a useful and accessible introduction to how doubt can be applied to this end, making an argument for the pragmatist approach to doubt as a tool for valuable, critical thinking. Gonzalo Echeverria's series of delicate black and white landscape photographs, one of which we have placed at the opening of each article, are all located within walking distance of his home in Nidé, Turkey. He deliberately avoids the 'true' blacks and whites of black and white photography which were once the holy grail of Ansel Adams and Edward Weston and with which we are now so familiar. Working with analogue equipment and on film, and printing his work in a traditional darkroom (and even mixing his own custom chemicals) Echeverria creates a range of greys which recall the early days of photography. Yet these images are undeniably rooted in the present both culturally and photographically. The recurring presence, and at times almost absence, of the minuets in the photographs asks us to consider doubt as much faith. In our formulation then, doubt has two sides. It can be a subject – like any other – which we can study and consider using the tools of scholarship founded on objectivity and the norms of knowledge production. Yet, doubt also has the potential to challenge those accepted methods. The definition of knowledge at the base of all scholarship, and by association the methods used to acquire it, has its foundations in Descartes’s formulation that what counts as knowledge is a conviction which is beyond doubt (Newman). In the method that leads to knowledge so-defined “doubt is predicated only to be ingeniously harnessed as the means of its own overcoming” (Fleissner 116). In her fascinating analysis of Obsessive Compulsive Disorder as being founded on doubt rather than obsession, Fleissner traces the extent to which the role of doubt in the project of modernity is far more complicated than this definition of knowledge and its production implies. It appears, Fleissner argues, that Descartes’s revolutionary formulation of the cogito (“I am thinking, therefore I exist”) (Baron) “depends on recasting… doubts as themselves proof of the one thing, thought, that cannot be doubted” (Fleissner 115). Indeed, the use of doubt in the methodology inaugurated by Descartes “construes sceptical doubts as the ground clearing tools of epistemic demolition” (Newman, emphasis in original). As Fleissner discusses, the perceived potential for this demolition to produce mania and madness has haunted modernity, and proved a difficult problem for psychology. Despite Descartes’s insistence that this demolition ultimately lead to construction (Newman, see also Macarthur in this issue), there is a persistent fear that once doubting has begun, it cannot be brought to an end (Fleissner 113-20). Over the years that we have discussed the possibility of a methodology of doubt with colleagues and peers, an expression of this fear has been the most consistent response. On closer inspection we can see that doubt is asked to play numerous, conflicting roles in the epistemology inaugurated by Descartes: it is a tool (or, as Newman characterisies it, a “bulldozer”) in the project of knowledge production; its presence is used as criteria for dismissing false knowledge; and its presence in the mind of the philosopher is taken as evidence of his existence. As Fleissner suggests: Indeed, what is perhaps most striking about The Meditations Concerning First Philosophy is the sense that Descartes wishes both to be rid of doubt and to preserve it; it is this combination, not the final overcoming of doubt in favour of the certainty of the mind’s powers, that the cogito might be said most strongly to install. (133) Let us now apologise if the above paragraphs offend our philosopher colleagues, for we have likely clumsily wandered through foundational arguments in the discipline that have a level of nuance and complexity to which we have not given adequate acknowledgment. However, m/c is a journal of media and culture, and for us what is interesting about the argument presented above is its potential to draw our attention to the conundrum presented by doubt and doubting in fields far removed from disciplined and technical arguments about epistemology. We are interested in how the foundational arguments presented by Descartes, and the complex status of doubt within them, have continued ramifications far beyond their original context. We are interested, in a way, in their trace in contemporary media culture and in the scholarship and creative practice that engages with it. At the end of her article, Fleissner concludes with a hope “for a doubt with a voice of its own” (134), and it is the potential for doubt to positively influence our ways of writing about our thinking that has attracted us to it. We should not hold Descartes responsible for the flow-on effects that his epistemology has had on writing in the humanities, but we do believe that the continued trace of the Cartesian method has lead to ossification of the expression of research. This part of the introduction is a perfect example of this: dense, littered with references, cautious yet authoritarian. The doubts I have had whilst writing it are silenced in order for the writing to proceed. The speaking-position required to perform the Cartesian method is, let’s be honest, not one which can often result in writing that can even hope to engage or inspire readers who do not wish to be the audience for a performance of the author’s ability to be disciplined. (And of course, as I write that sentence I consider how many readers will not make it through the proceeding paragraphs to get to this point. They’ll find the whole ‘Descartes bit’ too dry or dense.) We too want to know about how doubt might find a voice of its own, and are particularly interested in how doubt might be kept in focus in the writing of research, rather than be a point of departure that is ultimately erased. ** (The Dutch writer Gerard van't Reve once began an autobiographical piece with the words: “I was born stupid, as my father used to say”. My father never said this — and in fact I rather suffered from the inverse or opposite problem — but it is such a lovely opening that I would like to make use of it.) I was born stupid, but my mother was always telling people how smart I was. And like most people I just assumed that my parents always spoke the truth. Luckily, I was good at creating the impression that I was intelligent. But it took me a long time to work out that my mother was wrong and that parents are capable of saying things that are not true. For example my father was a great practical joker. He loved the idea that a child would believe anything you said. When I was five he told me that chewing gum was made from old bicycle tyres. It was not until I was about thirty years old that I suddenly realised this was not the case. It was not as if I actively continued to believe for a quarter of a century that chewing gum is actually made from old bicycle tyres. It is unlikely that I thought about what chewing gum is made of during those twenty five years at all. But my five year old self had stored this 'fact' in the part of my brain where things are stored about which there is no doubt. And when I accidentally chanced upon it there many years later, he had been dead for more than ten years. It was like the last pocket money cheque he sent which I received the day after I arrived home from his funeral, only funnier. My father loved to laugh and he loved to make other people laugh. This is why my mother fell in love with him. The problem was he also loved a drink or two and my mother didn't drink, neither did my grandmother, or anyone else in her family. This would later turn into a problem for everyone. But his alcoholism was still in its early stages when he married my mother, and it is easy to hide your drinking from people who don't drink: it is just not within their realm of possibilities that you would go to a bar after you kiss them goodbye at the end of the evening instead of going home to go to bed and sleep. I think it was because my mother desperately wanted an intelligent child that she was always telling people how smart I was. I think all of my family on my mother’s side spent their lives wishing they were just a little bit more intelligent, and pretending that they were. So this is where I got my gift. I just did what everyone else did. This stood me in good stead when I moved to an English speaking country where, when I had no idea what was being said, I just tried to look intelligent and pretended to understand. And generally that worked pretty well. Not many people are game to challenge other people's understanding. If it seems like you do (or should) understand, most people assume that you do. In places where you would expect people’s understanding to be challenged, such as universities, this now results in negative student feedback which academics have to explain at their performance management meetings. In today’s universities academics are expected to be dispensers of information who only utter absolute truths. The job of a student is to put the received information into that part of the brain where things are stored about which there is no doubt. And in Zygmunt Bauman’s liquid society, "where the individual must act, plan actions and calculate the likely gains and losses of acting (or failing to act) under conditions of endemic uncertainty" (4), the ability to conceal your doubt is your most crucial weapon. ** In her mythologising of Donald Crowhurst, Tacita Dean unwittingly animates the key terms of any consideration of doubt: fear, imagination and denial. For many, doubt cannot be disconnected from these properties that can be energised by its presence. Doubt always carries with it the potential to turn on those who acknowledge it and seek to apply it, to ricochet off the subject of doubt and create a doubting subject. Doubt is seen as the trigger for uncontrollable fantasies of failure. This issue attempts to untie this association. And we look forward to the companion issue of m/c, on failure, that will hopefully appear in the journal’s future. We would like to thank: the authors, Gonzalo Echeverria, Stephen Hetherington, and our peer reviewers for their willingness to assist us in developing this issue. We also thank Axel Bruns for his support. References Bauman, Zygmunt. Liquid Times: Living in an Age of Uncertainty. Cambridge: Polity Press, 2007. Fleissner, Jennifer L. “Obsessional Modernity: The ‘Institutionalization of Doubt’.” Critical Inquiry 34 (Autumn 2007): 106-134. Newman, Lex. “Descartes' Epistemology”. The Stanford Encyclopedia of Philosophy (Fall 2010 Edition). Ed. Edward N. Zalta. ‹http://plato.stanford.edu/entries/descartes-epistemology/›. Reed, Baron. "Certainty." The Stanford Encyclopedia of Philosophy (Fall 2008 Edition). Ed. Edward N. Zalta. ‹http://plato.stanford.edu/entries/certainty/›. Warner, Marina. “Interview with Tacita Dean.” In Jean-Christophe Royoux, Marina Warner and Germaine Greer. Tacita Dean. New York: Phaidon, 2006. 7-41.

Economics of Cute There are many ways to study cute: for example, neuro-biology (cute as adaptation); anthropology (cute in culture); political economy (cute industries, how cute exploits consumers); cultural studies (social construction of cute); media theory and politics (representation and identity of cute), and so on. What about economics? At first sight, this might point to a money-capitalism nexus (“the cute economy”), but I want to argue here that the economics of cute actually works through choice interacting with fixed costs and what economists call ”the substitution effect”. Cute, in conjunction with the Internet, affects the trade-offs involved in choices people make. Let me put that more starkly: cute shapes the economy. This can be illustrated with internet animals, which at the time of writing means Grumpy Cat. I want to explain how that mechanism works – but to do so I will need some abstraction. This is not difficult – a simple application of a well-known economics model, namely the Allen-Alchian theorem, or the “third law of demand”. But I am going to take some liberties in order to represent that model clearly in this short paper. Specifically, I will model just two extremes of quality (“opera” and “cat videos”) to represent end-points of a spectrum. I will also assume that the entire effect of the internet is to lower the cost of cat videos. Now obviously these are just simplifying assumptions “for the purpose of the model”. And the purpose of the model is to illuminate a further aspect of how we might understand cute, by using an economic model of choice and its consequences. This is a standard technique in economics, but not so in cultural studies, so I will endeavour to explain these moments as we go, so as to avoid any confusion about analytic intent. The purpose of this paper is to suggest a way that a simple economic model might be applied to augment the cultural study of cute by seeking to unpack its economic aspect. This can be elucidated by considering the rise of internet animals as a media-cultural force, as epitomized by “cat videos”. We can explain this through an application of price theory and the theory of demand that was first proposed by Armen Alchian and William Allen. They showed how an equal fixed cost that was imposed to both high-quality and low-quality goods alike caused a shift in consumption toward the higher-quality good, because it is now relatively cheaper. Alchian and Allen had in mind something like transport costs on agricultural goods (such as apples). But it is also true that the same effect works in reverse (Cowen), and the purpose of this paper is to develop that logic to contribute to explaining how certain structural shifts in production and consumption in digital media, particularly the rise of blog formats such as Tumblr, a primary supplier of kittens on the Internet, can be in part understood as a consequence of this economic mechanism. There are three key assumptions to build this argument. The first is that the cost of the internet is independent of what it carries. This is certainly true at the level of machine code, and largely true at higher levels. What might be judged aesthetically high quality or low quality content – say of a Bach cantata or a funny cat video – are treated the same way if they both have the same file size. This is a physical and computational aspect of net-neutrality. The internet – or digitization – functions as a fixed cost imposed regardless of what cultural quality is moving across it. Second, while there are costs to using the internet (for example, in hardware or concerning digital literacy) these costs are lower than previous analog forms of information and cultural production and dissemination. This is not an empirical claim, but a logical one (revealed preference): if it were not so, people would not have chosen it. The first two points – net neutrality and lowered cost – I want to take as working assumptions, although they can obviously be debated. But that is not the purpose of the paper, which is instead the third point – the “Alchian-Allen theorem”, or the third fundamental law of demand. The Alchian-Allen Theorem The Alchian-Allen theorem is an extension of the law of demand (Razzolini et al) to consider how the distribution of high quality and low quality substitutes of the same good (such as apples) is affected by the imposition of a fixed cost (such as transportation). It is also known as the “shipping the good apples out” theorem, after Borcherding and Silberberg explained why places that produce a lot of apples – such as Seattle in the US – often also have low supplies of high quality apples compared to places that do not produce apples, such as New York. The puzzle of “why can’t you get good apples in Seattle?” is a simple but clever application of price theory. When a place produces high quality and low quality items, it will be rational for those in faraway places to consume the high quality items, and it will be rational for the producers to ship them, leaving only the low quality items locally.Why? Assume preferences and incomes are the same everywhere and that transport cost is the same regardless of whether the item shipped is high or low quality. Both high quality and low quality apples are more expensive in New York compared to Seattle, but because the fixed transport cost applies to both the high quality apples are relatively less expensive. Rational consumers in New York will consume more high quality apples. This makes fewer available in Seattle.Figure 1: Change in consumption ratio after the imposition of a fixed cost to all apples Another example: Australians drink higher quality Californian wine than Californians, and vice versa, because it is only worth shipping the high quality wine out. A counter-argument is that learning effects dominate: with high quality local product, local consumers learn to appreciate quality, and have different preferences (Cowen and Tabarrok).The Alchian-Allen theorem applies to any fixed cost that applies generally. For example, consider illegal drugs (such as alcohol during the US prohibition, or marijuana or cocaine presently) and the implication of a fixed penalty – such as a fine, or prison sentence, which is like a cost – applied to trafficking or consumption. Alchian-Allen predicts a shift toward higher quality (or stronger) drugs, because with a fixed penalty and probability of getting caught, the relatively stronger substance is now relatively cheaper. Empirical work finds that this effect did occur during alcohol prohibition, and is currently occurring in narcotics (Thornton Economics of Prohibition, "Potency of illegal drugs").Another application proposed by Steven Cuellar uses Alchian-Allen to explain a well-known statistical phenomenon why women taking the contraceptive pill on average prefer “more masculine” men. This is once again a shift toward quality predicted on falling relative price based on a common ‘fixed price’ (taking the pill) of sexual activity. Jean Eid et al show that the result also applies to racehorses (the good horses get shipped out), and Staten and Umbeck show it applies to students – the good students go to faraway universities, and the good student in those places do the same. So that’s apples, drugs, sex and racehorses. What about the Internet and kittens?Allen-Alchian Explains Why the Internet Is Made of CatsIn analog days, before digitization and Internet, the transactions costs involved with various consumption items, whether commodities or media, meant that the Alchian-Allen effect pushed in the direction of higher quality, bundled product. Any additional fixed costs, such as higher transport costs, or taxes or duties, or transactions costs associated with search and coordination and payment, i.e. costs that affected all substitutes in the same way, would tend to make the higher quality item relatively less expensive, increasing its consumption.But digitisation and the Internet reverse the direction of these transactions costs. Rather than adding a fixed cost, such as transport costs, the various aspects of the digital revolution are equivalent to a fall in fixed costs, particularly access.These factors are not just one thing, but a suite of changes that add up to lowered transaction costs in the production, distribution and consumption of media, culture and games. These include: The internet and world-wide-web, and its unencumbered operation The growth and increasing efficacy of search technology Growth of universal broadband for fast, wide band-width access Growth of mobile access (through smartphones and other appliances) Growth of social media networks (Facebook, Twitter; Metcalfe’s law) Growth of developer and distribution platforms (iPhone, android, iTunes) Globally falling hardware and network access costs (Moore’s law) Growth of e-commerce (Ebay, Amazon, Etsy) and e-payments (paypal, bitcoin) Expansions of digital literacy and competence Creative commons These effects do not simply shift us down a demand curve for each given consumption item. This effect alone simply predicts that we consume more. But the Alchian-Allen effect makes a different prediction, namely that we consume not just more, but also different.These effects function to reduce the overall fixed costs or transactions costs associated with any consumption, sharing, or production of media, culture or games over the internet (or in digital form). With this overall fixed cost component now reduced, it represents a relatively larger decline in cost at the lower-quality, more bite-sized or unbundled end of the media goods spectrum. As such, this predicts a change in the composition of the overall consumption basket to reflect the changed relative prices that these above effects give rise to. See Figure 2 below (based on a blog post by James Oswald). The key to the economics of cute, in consequence of digitisation, is to follow through the qualitative change that, because of the Alchian-Allen effect, moves away from the high-quality, highly-bundled, high-value end of the media goods spectrum. The “pattern prediction” here is toward more, different, and lower quality: toward five minutes of “Internet animals”, rather than a full day at the zoo. Figure 2: Reducing transaction costs lowers the relative price of cat videos Consider five dimensions in which this more and different tendency plays out. Consumption These effects make digital and Internet-based consumption cheaper, shifting us down a demand curve, so we consume more. That’s the first law of demand in action: i.e. demand curves slope downwards. But a further effect – brilliantly set out in Cowen – is that we also consume lower-quality media. This is not a value judgment. These lower-quality media may well have much higher aesthetic value. They may be funnier, or more tragic and sublime; or faster, or not. This is not about absolute value; only about relative value. Digitization operating through Allen-Alchian skews consumption toward the lower quality ends in some dimensions: whether this is time, as in shorter – or cost, as in cheaper – or size, as in smaller – or transmission quality, as in gifs. This can also be seen as a form of unbundling, of dropping of dimensions that are not valued to create a simplified product.So we consume different, with higher variance. We sample more than we used to. This means that we explore a larger information world. Consumption is bite-sized and assorted. This tendency is evident in the rise of apps and in the proliferation of media forms and devices and the value of interoperability.ProductionAs consumption shifts (lower quality, greater variety), so must production. The production process has two phases: (1) figuring out what to do, or development; and (2) doing it, or making. The world of trade and globalization describes the latter part: namely efficient production. The main challenge is the world of innovation: the entrepreneurial and experimental world of figuring out what to do, and how. It is this second world that is radically transformed by implications of lowered transaction costs.One implication is growth of user-communities based around collaborative media projects (such as open source software) and community-based platforms or common pool resources for sharing knowledge, such as the “Maker movement” (Anderson 2012). This phenomenon of user-co-creation, or produsers, has been widely recognized as an important new phenomenon in the innovation and production process, particularly those processes associated with new digital technologies. There are numerous explanations for this, particularly around preferences for cooperation, community-building, social learning and reputational capital, and entrepreneurial expectations (Quiggin and Potts, Banks and Potts). Business Models The Alchian-Allen effect on consumption and production follows through to business models. A business model is a way of extracting value that represents some strategic equilibrium between market forms, organizational structures, technological possibilities and institutional framework and environmental conditions that manifests in entrepreneurial patterns of business strategy and particular patterns of investment and organization. The discovery of effective business models is a key process of market capitalist development and competition. The Alchian-Allen effect impacts on the space of effective viable business models. Business models that used to work will work less well, or not at all. And new business models will be required. It is a significant challenge to develop these “economic technologies”. Perhaps no less so than development of the physical technologies, new business models are produced through experimental trial and error. They cannot be known in advance or planned. But business models will change, which will affect not only the constellation of existing companies and the value propositions that underlie them, but also the broader specializations based on these in terms of skill sets held and developed by people, locations of businesses and people, and so on. New business models will emerge from a process of Schumpeterian creative destruction as it unfolds (Beinhocker). The large production, high development cost, proprietary intellectual property and systems based business model is not likely to survive, other than as niche areas. More experimental, discovery-focused, fast-development-then-scale-up based business models are more likely to fit the new ecology. Social Network Markets & Novelty Bundling MarketsThe growth of variety and diversity of choice that comes with this change in the way media is consumed to reflect a reallocation of consumption toward smaller more bite-sized, lower valued chunks (the Alchian-Allen effect) presents consumers with a problem, namely that they have to make more choices over novelty. Choice over novelty is difficult for consumers because it is experimental and potentially costly due to risk of mistakes (Earl), but it also presents entrepreneurs with an opportunity to seek to help solve that problem. The problem is a simple consequence of bounded rationality and time scarcity. It is equivalent to saying that the cost of choice rises monotonically with the number of choices, and that because there is no way to make a complete rational choice, agents will use decision or choice heuristics. These heuristics can be developed independently by the agents themselves through experience, or they can be copied or adopted from others (Earl and Potts). What Potts et al call “social network markets” and what Potts calls “novelty bundling markets” are both instances of the latter process of copying and adoption of decision rules. Social network markets occur when agents use a “copy the most common” or “copy the highest rank” meta-level decision rule (Bentley et al) to deal with uncertainty. Social network markets can be efficient aggregators of distributed information, but they can also be path-dependent, and usually lead to winner-take all situations and dynamics. These can result in huge pay-offs differentials between first and second or fifth place, even when the initial quality differentials are slight or random. Diversity, rapid experimentation, and “fast-failure” are likely to be effective strategies. It also points to the role of trust and reputation in using adopted decision rules and the information economics that underlies that: namely that specialization and trade applies to the production and consumption of information as well as commodities. Novelty bundling markets are an entrepreneurial response to this problem, and observable in a range of new media and creative industries contexts. These include arts, music or food festivals or fairs where entertainment and sociality is combined with low opportunity cost situations in which to try bundles of novelty and connect with experts. These are by agents who developed expert preferences through investment and experience in consumption of the particular segment or domain. They are expert consumers and are selling their “decision rules” and not just the product. The more production and consumption of media and digital information goods and services experiences the Alchian-Allen effect, the greater the importance of novelty bundling markets. Intellectual Property & Regulation A further implication is that rent-seeking solutions may also emerge. This can be seen in two dimensions; pursuit of intellectual property (Boldrin and Levine); and demand for regulations (Stigler). The Alchian-Allen induced shift will affect markets and business models (and firms), and because this will induce strategic defensive and aggressive responses from different organizations. Some organizations will seek to fight and adapt to this new world through innovative competition. Other firms will fight through political connections. Most incumbent firms will have substantial investments in IP or in the business model it supports. Yet the intellectual property model is optimized for high-quality large volume centralized production and global sales of undifferentiated product. Much industrial and labour regulation is built on that model. How governments support such industries is predicated on the stability of this model. The Alchian-Allen effect threatens to upset that model. Political pushback will invariably take the form of opposing most new business models and the new entrants they carry. Conclusion I have presented here a lesser-known but important theorem in applied microeconomics – the Alchian-Allen effect – and explain why its inverse is central to understanding the evolution of new media industries, and also why cute animals proliferate on the Internet. The theorem states that when a fixed cost is added to substitute goods, consumers will shift to the higher quality item (now relatively less expensive). The theorem also holds in reverse, when a fixed cost is removed from substitute items we expect a shift to lower quality consumption. The Internet has dramatically lowered fixed costs of access to media consumption, and various development platforms have similarly lowered the costs of production. Alchian-Allen predicts a shift to lower-quality, ”bittier” cuter consumption (Cowen). References Alchian, Arman, and William Allen. Exchange and Production. 2nd ed. Belmont, CA: Wadsworth, 1967. Anderson, Chris. Makers. New York: Crown Business, 2012. Banks, John, and Jason Potts. "Consumer Co-Creation in Online Games." New Media and Society 12.2 (2010): 253-70. Beinhocker, Eric. Origin of Wealth. Cambridge, Mass.: Harvard University Press, 2005. Bentley, R., et al. "Regular Rates of Popular Culture Change Reflect Random Copying." Evolution and Human Behavior 28 (2007): 151-158. Borcherding, Thomas, and Eugene Silberberg. "Shipping the Good Apples Out: The Alchian and Allen Theorem Reconsidered." Journal of Political Economy 86.1 (1978): 131-6. Cowen, Tyler. Create Your Own Economy. New York: Dutton, 2009. (Also published as The Age of the Infovore: Succeeding in the Information Economy. Penguin, 2010.) Cowen, Tyler, and Alexander Tabarrok. "Good Grapes and Bad Lobsters: The Alchian and Allen Theorem Revisited." Journal of Economic Inquiry 33.2 (1995): 253-6. Cuellar, Steven. "Sex, Drugs and the Alchian-Allen Theorem." Unpublished paper, 2005. 29 Apr. 2014 ‹http://www.sonoma.edu/users/c/cuellar/research/Sex-Drugs.pdf›.Earl, Peter. The Economic Imagination. Cheltenham: Harvester Wheatsheaf, 1986. Earl, Peter, and Jason Potts. "The Market for Preferences." Cambridge Journal of Economics 28 (2004): 619–33. Eid, Jean, Travis Ng, and Terence Tai-Leung Chong. "Shipping the Good Horses Out." Wworking paper, 2012. http://homes.chass.utoronto.ca/~ngkaho/Research/shippinghorses.pdf Potts, Jason, et al. "Social Network Markets: A New Definition of Creative Industries." Journal of Cultural Economics 32.3 (2008): 166-185. Quiggin, John, and Jason Potts. "Economics of Non-Market Innovation & Digital Literacy." Media International Australia 128 (2008): 144-50. Razzolini, Laura, William Shughart, and Robert Tollison. "On the Third Law of Demand." Economic Inquiry 41.2 (2003): 292–298. Staten, Michael, and John Umbeck. “Shipping the Good Students Out: The Effect of a Fixed Charge on Student Enrollments.” Journal of Economic Education 20.2 (1989): 165-171. Stigler, George. "The Theory of Economic Regulation." Bell Journal of Economics 2.1 (1971): 3-22. Thornton, Mark. The Economics of Prohibition. Salt Lake City: University of Utah Press, 1991.Thornton, Mark. "The Potency of Illegal Drugs." Journal of Drug Issues 28.3 (1998): 525-40.

Photo by Waranont (Joe) on Unsplash INTRODUCTION The age-adjusted COVID-19 mortality rate among Black Americans is twice as high as White Americans.[1] This shocking evidence of health disparities, coincident to a public reckoning with the history of racism in the US, highlights the inverse relationship between race and health. Public sentiment may now favor addressing these pressing public health issues, but the sprawling healthcare system largely focuses on clinical care; it lacks tools to influence the social determinants of health at the point of the healthcare institution. Reinvigorating organizational ethics, sometimes called institutional ethics, may provide such a tool. BACKGROUND Organizational ethics became part of the healthcare system during the upheavals in financing and organization of health care in the 1990s. Yet organizational ethics in a medical setting must be more than simple business ethics.[2] Just as health care professionals are granted special privileges in society in exchange for adherence to a code of medical ethics and duties, healthcare organizations and systems also must now adhere to ethical requirements in exchange for their privileged position that includes the right to provide, and be reimbursed for, health care.[3] In the 1990s, ethicists began to discuss how clinical ethics committees might develop an understanding of business ethics in order to provide comprehensive organizational ethics reviews.[4] Some bioethicists even believed that the challenges of integrating business and medical care would compel ethics committees to look outward, engaging in public advocacy around ethical issues in health care.[5] To fulfill the mission of maintaining organizational ethics standards within the healthcare system, ethics committees would need to advocate for patients in the public sphere. Ethics committees might even take positions at odds with those of the healthcare institutions in which they work. Organizational ethics committees might have served as watchdogs, ensuring that healthcare organizations fulfill their fiduciary duties to their patients and communities. Bioethicists soon realized that the vision of a robust ethics committee involving administrators, bioethicists, and medical staff advising multiple divisions of large organizations and policy makers would fall short.[6] The two ethical systems remained separate: most organizations developed a combination of a clinical ethics committee adjunct to the medical staff with a compliance department to oversee organizational ethics. However, organizational ethics really goes beyond compliance; it “cannot be addressed by focusing narrowly on business matters or by quasi-legal mechanisms to assure that behavior conforms to pre-established codes or rules.”[7] As a result, there is no centralized entity with power in each healthcare institution that can treat healthcare inequities as an institutional ethical failure that must be addressed. Current research on specific inequitable outcomes due to bias in clinical care includes specialties such as maternal care,[8]cardiac care,[9] pain management, and technology.[10] Implicit bias and racist clinical interactions, once identified, may be addressed through staff training and other interventions. Yet the ethics of clinical care requires little attention to the social determinants of health such as high levels of police surveillance in the community which may cause increased rates of hypertension,[11] pre-term birth,[12] and may affect mental health. Leaving these problems to the public health realm disconnects health practitioners and institutions from the ability to remedy some of the causes of health problems in their patients. Simply treating the effects of racism in the practice of medicine is not curative – it is really palliative care.[13] ANALYSIS The term “organizational ethics” is too limited to encompass the scope of change needed to address structural racism and the social determinants of health in today’s healthcare institutions. Structural Justice Ethics[14] better describes a plan and a process that requires the healthcare system and professionals to look both inward and outward to take on the structural causes of racism and health disparities. Building on organizational and clinical ethics, Structural Justice Ethics could amplify the research on systemic issues such as the effects of social determinants of health, racism in clinical care, and necessary advocacy with the local community. To be effective and complete, organizations should recognize duties to patients that arrive at their doorstep, damaged by generations of subordination and racism. To ethically treat patients who have experienced racism, the system and health practitioners must acknowledge and work to reduce the inequities in society that cause harm to their health in the clinical setting. Accreditation companies such as The Joint Commission could amend their standards to require top-rated healthcare organizations to form new Structural Justice Ethics committees in their organizations, taking affirmative steps to acknowledge the ethical implications of racism and the social determinants of health. Many bioethicists have already called for the field of bioethics to address racism as an ethical issue in healthcare, some even calling for a new Black Bioethics.[15] This frustration with the profession of bioethics has developed in other areas, such as disability ethics and feminist ethics, and reflects a belief that mainstream bioethics is a rigidly principlist endeavor. The education of new bioethicists is grounded in practical philosophy graduate programs, entwined with academia’s history of exclusivity. As a relatively young academic subject, bioethics has the potential to expand and grow into a more practical and justice-oriented tool, learning how to counter the overly individualistic bioethics that has roots in our racist and Protestant-dominant history.[16] Expanding organizational ethics into Structural Justice Ethics in health care could bring Black bioethicists into the center of healthcare ethics and provide the tools to implement changes needed to address racism in health care. Healthcare organizations should not expect Black healthcare practitioners to take on these Structural Justice Ethics roles as “extra” work. Too often, people of color are expected to bear the burden of explaining racism and working to eradicate it.[17]The Structural Justice Ethics committee should be a new model, centered in ethics and policy, with professional-level staffing that reflects the racial and ethnic makeup of the community it serves. Calling on bioethicists as moral agents in the world, and particularly within the medical system, to act as social justice advocates against systemic injustice in a system where they have privilege and power seems logical and surprisingly necessary. “Going forward, bioethics needs to engage with the nuances of race with the same vigor that it has approached discussions of moral theories and biotechnologies.”[18] Graduate-level bioethics programs have expanded significantly in recent years, with 45 current master’s level programs,[19] and there should be a wealth of professionals ready to oversee the role of encouraging and monitoring justice in the system. These programs focus primarily if not exclusively on the dominant paradigm of bioethics, yet as ethics programs, they should be able to course-correct and embrace greater diversity in people and thought. Structural Justice Ethicists can guide healthcare organizations to become learning institutions open to the idea that bias and inequity are ethical harms that they can and should address. Some may question whether such close attention to Black health care needs amounts to reparations or “reverse” discrimination, a controversial topic in our political discussions. However, when posed as an ethical duty of health care, there is no option to continue to treat Black people unethically. Of course, healthcare systems will have to balance competing budgetary interests; even with unlimited funding, disparities in health care would not disappear overnight.[20] In a fair process where decisionmakers must weigh the demands of stakeholders, the ethical obligation to address the social determinants of health must have an advocate. Moreover, setting high ethical standards is not the same as government spending to make reparations for past harms. In fact, Structural Justice Ethics does not look to the past at all but looks to the needs of subordinated communities of patients as they exist today. Any community that is harmed by structural injustice in health care can be the focus of a Structural Justice Ethics review. The Joint Commission and other accrediting organizations can require healthcare organizations to meet the challenges of health inequities by adopting new Structural Justice Ethics committees, just as The Joint Commission added organizational ethics to its requirements in 1995. Admittedly, Structural Justice Ethics is an amorphous concept and its role within healthcare institutions needs to be refined and assigned specific tasks. However, there is substantial research on the social determinants of health; the challenge for the Structural Justice Ethics is to recommend systemic changes from within, rather than beginning this research anew. The Joint Commission’s Center for Transforming Healthcare, as a data-driven and process-oriented patient safety organization, is well-primed to take on this task. The Center can collaborate with existing academic and governmental health equity researchers to set short- and long-term goals for Structural Justice Ethics committees. To begin with, a Structural Justice Ethics committee can pose the question of “how is racism operating here” and: a. connect with current research on specific inequitable outcomes due to bias in medicine and bring best practices to the attention of medical staff. b. work with human resources and medical staff to support and increase diverse populations in the workforce. c. ensure that implicit bias and other trainings are properly provided to all staff, as well as expanding the scope of such trainings to address developing areas such as epistemic harm, or the harm of one’s own physical experience being discounted by medical professionals.[21] The health care workforce should also be trained in Title VI law.[22] d. evaluate research data on the organization’s own potential disparate outcomes due to race, to determine areas for improvement both within and outside of the organization. e. invite the local community to come in for listening and learning sessions, to better understand the community’s concerns and perspective on health equity. f. improve advocacy on behalf of community members to state and local authorities, effectively taking a stand for health care equity for local stakeholders. Dr. Camara P. Jones describes a collaborative endeavor like this as critical to anti-racist work and likens it to adopting a community health center model where the health facility takes responsibility for the health and well-being of the local community.[23] AMA policy already encourages this type of effort in opinion 8.11 of the AMA Code, which states that, alongside diagnosis and treatment, “physicians also have a professional commitment to prevent disease and promote health and well-being for their patients and the community.”[24] A theoretical framework and concrete plan for radical improvement in the ethics of the healthcare system will help all healthcare professionals. Some healthcare practitioners may not recognize their own biases and need training to meet best practices standards in light of health inequities. Other healthcare practitioners may feel disillusioned because they know they face individual patients suffering the effects of structural racism, yet they can treat only the illness.[25] The scope of the problem may overwhelm practitioners, and without a belief that the system is committed to improvement, practitioners may become numb to the suffering, a trauma reaction that affects both the practitioners and their patients. Unfortunately, when current medical students ask the question, “what can I do to fight systemic racism?” the answer is usually “call it out.” But putting the onus on newly minted individual practitioners to call out racism in an established structure is unrealistic, unfair, and destined to be unsuccessful. Just as we should not expect subordinated individuals to “overcome” their social determinants of health, we should not expect health professionals to make this change individually. Addressing injustices in the institution and adjusting medical ethics accordingly can alleviate the burden of these ethical dilemmas. CONCLUSION Structural Justice Ethics must be woven into the ethics committees at the institutional level. Organizational ethics committees can evaluate healthcare organizations by their integrity, i.e., how well their actions fulfill the moral obligations they have undertaken.[26] Our healthcare system has avoided the moral obligation to address racism and the social determinants of health by focusing on clinical ethics, leaving public health to academics and the government. Expanding organizational ethics to take on the issues of structural injustice within each healthcare institution will help organizations better measure, change, and ultimately fulfill their moral obligations to their patients and communities. [1] “Color of Coronavirus: COVID-19 Deaths Analyzed by Race and Ethnicity,” APM Research Lab, accessed June 1, 2021, https://www.apmresearchlab.org/covid/deaths-by-race. [2] M. Constantinescu, “Seeing the Forest beyond the Trees: A Holistic Approach to Health-Care Organizational Ethics,” in Contemporary Debates in Bioethics: European Perspectives, 2018, 86–96, https://doi.org/10.2478/9783110571219-009. [3] See Norman Daniels, Just Health: Meeting Health Needs Fairly (Cambridge: Cambridge University Press, 2008) at 219. [4] Elizabeth Heitman and Ruth Ellen Bulger, “The Healthcare Ethics Committee in the Structural Transformation of Health Care: Administrative and Organizational Ethics in Changing Times,” HEC Forum 10, no. 2 (June 1, 1998): 152–76, 162, https://doi.org/10.1023/A:1008865603499. [5] Cohen, Cynthia B. "Ethics Committees as Corporate and Public Policy Advocates." The Hastings Center Report 20, no. 5 (1990): 36+. Gale Academic OneFile (accessed May 6, 2021). https://link.gale.com/apps/doc/A8998890/AONE?u=nysl_oweb&sid=AONE&xid=84a1cade. [6] Linda L. Emanuel, “Ethics and the Structures of Healthcare Special Section: Issues in Organization Ethics and Healthcare,” Cambridge Quarterly of Healthcare Ethics 9, no. 2 (2000): 151–68, 166. [7] George Khushf and Rosemarie Tong, “Setting Organizational Ethics within a Broader Social and Legal Context,” HEC Forum 14, no. 2 (June 2002): 77–85, 78. [8] Olivia Pham, Usha Ranji Published: Nov 10, and 2020, “Racial Disparities in Maternal and Infant Health: An Overview - Issue Brief,” KFF (blog), November 10, 2020, https://www.kff.org/report-section/racial-disparities-in-maternal-and-infant-health-an-overview-issue-brief/. [9] Eberly Lauren A. et al., “Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center,” Circulation: Heart Failure 12, no. 11 (November 1, 2019): e006214, https://doi.org/10.1161/CIRCHEARTFAILURE.119.006214. [10] Michael W. Sjoding et al., “Racial Bias in Pulse Oximetry Measurement,” New England Journal of Medicine 383, no. 25 (December 17, 2020): 2477–78, https://doi.org/10.1056/NEJMc2029240. [11] Alyasah Ali Sewell et al., “Illness Spillovers of Lethal Police Violence: The Significance of Gendered Marginalization,” Ethnic and Racial Studies 44, no. 7 (July 22, 2020): 1–26, https://doi.org/10.1080/01419870.2020.1781913. [12] Brad N. Greenwood et al., “Physician–Patient Racial Concordance and Disparities in Birthing Mortality for Newborns,” Proceedings of the National Academy of Sciences 117, no. 35 (September 1, 2020): 21194–200, https://doi.org/10.1073/pnas.1913405117. [13] The term “palliative care” as applied to patients suffering from the social determinants of health was used by Dr. Michelle Morse at a webinar entitled “Medical Stereotypes: Confronting Racism and Disparities in US Health Care: A Health Policy and Bioethics Consortium” presented by the Harvard Petrie-Flom Center on February 12, 2021. [14] Linda L. Emanuel coined the term “Structural Ethics” in 2000. This term did not seem to generate much interest from the bioethics community at the time. Her explanation of this term is consistent with my thinking, although I expand it to address the health system as an entity, and focus on improving health equity. [15] Keisha Shantel Ray, “Black Bioethics and How the Failures of the Profession Paved the Way for Its Existence | Bioethics.Net,” www.bioethics.net, August 6, 2020, http://www.bioethics.net/2020/08/black-bioethics-and-how-the-failures-of-the-profession-paved-the-way-for-its-existence/; Yolonda Y. Wilson, “Racial Injustice and Meaning Well: A Challenge for Bioethics,” The American Journal of Bioethics 21, no. 2 (February 1, 2021): 1–3, https://doi.org/10.1080/15265161.2020.1866875. [16] See Catherine Myser, “Differences from Somewhere: The Normativity of Whiteness in Bioethics in the United States,” The American Journal of Bioethics 3, no. 2 (May 2003): 1–11, https://doi.org/10.1162/152651603766436072. [17] Ushe Blackstock, “Why Black Doctors like Me Are Leaving Academic Medicine,” STAT (blog), January 16, 2020, https://www.statnews.com/2020/01/16/black-doctors-leaving-faculty-positions-academic-medical-centers/. [18] Zamina Mithani, Jane Cooper, and Boyd J. Wesley, “Race, Power, and COVID-19: A Call for Advocacy within Bioethics,” The American Journal of Bioethics21, no. 2 (2021): 11–18, 13 https://doi.org/10.1080/15265161.2020.1851810. [19] “Graduate Programs,” The Hastings Center, accessed 2 June, 2021, https://www.thehastingscenter.org/publications-resources/bioethics-careers-education/graduate-programs-2/. [20] Norman Daniels, Just Health: Meeting Health Needs Fairly, at 299. [21] Ian James Kidd and Havi Carel, “Epistemic Injustice and Illness,” Journal of Applied Philosophy 34, no. 2 (2017): 172–90, https://doi.org/10.1111/japp.12172. [22] Ruqaiijah Yearby, “Sick and Tired of Being Sick and Tired: Putting an End to Separate and Unequal Health Care in the United States 50 Years after the Civil Rights Act of 1964,” Health Matrix 25, no. 1 (January 1, 2015): 1–33, at 11. [23] Jones CP, Maybank A, Nolen L, Fields N, Ogunwole M, Onuoha C, Williams J, Tsai J, Paul D, Essien UR, Khazanchi, R. “Episode 5: Racism, Power, and Policy: Building the Antiracist Health Systems of the Future.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. January 19, 2021. [24] Sienna Moriarty, “AMA Policies and Code of Medical Ethics’ Opinions Related to Health Promotion and Community Development,” AMA Journal of Ethics 21, no. 3 (March 1, 2019): 259–61, https://doi.org/10.1001/amajethics.2019.259. [25] Constantinescu, “Seeing the Forest beyond the Trees,” at 92. [26] Ana Smith Iltis, “Organizational Ethics: Moral Obligation and Integrity,” in Institutional Integrity in Health Care, ed. Ana Smith Iltis, Philosophy and Medicine (Dordrecht: Springer Netherlands, 2003), 175–82, https://doi.org/10.1007/978-94-017-0153-2_10.