BackgroundBreast cancer patients are at elevated risk of depression during treatment, thus provoking the chance of poor clinical outcomes. This retrospective cohort study aimed to investigate whether integrating Chinese herbal medicines citation into conventional cancer therapy could decrease the risk of depression in the long-term breast cancer survivors.MethodsA cohort of patients aged 20–70 years and with newly diagnosed breast cancer during 2000–2008 was identified from a nationwide claims database. In this study, we focused solely on survivors of breast cancer at (...) least1 year after diagnosis. After one-to-one matching for age, sex, and baseline comorbidities, breast cancer patients who received and did not receive CHM treatment were enrolled. The incidence rate and hazard ratio citation for depression between the two groups was estimated at the end of 2012. A Cox proportional hazard model was constructed to examine the impact of the CHM use on the risk of depression.ResultsDuring the study period, the incidence rate of depression was significantly lower in the treated cohort than in the untreated cohort [8.57 compared with 11.01 per 1,000 person-years citation], and the adjusted HR remained significant at 0.74 in a Cox proportional hazards regression model. The corresponding risk further decreasing to 43% among those using CHM for more than 1 year.ConclusionFinding from this investigation indicated that the lower risk of depression observed in breast cancer patients treated with CHM, suggesting that CHM treatment should be considered for disease management toward breast cancer. Yet, the optimal administered dose should be determined in further clinical trials. (shrink)

The authors aim to explore a better fitting leadership style that is designed for the sustainable era in believing and committing to work for cherishing resources and developing the organization toward a new sustainable direction. This study developed the questionnaire items of the Resource-Dilemma-Handling-Leadership scale, representing a new sustainable era's new leadership style, and then to compare it with the transformational leadership style in order to highlight the importance of RHDL for sustainable development. This study took companies, which have more (...) than 100 employees in Taiwan as research samples. Those companies were selected because they were socially tagged as being operating continuously for more than 20 years and identifying themselves with the operational orientation of social responsibility as their business philosophy and core values for management. A total of 532 valid questionnaires were collected, with a 90.6% valid return rate, and tested with the SEM method. Consistent with the authors' inferences from the literature, the test results suggest that CSR plays the role of full mediator between RDHL and OC. CSR itself is like a sense of responsibility, giving employees a sense of mission, to complete meaningful sustainability-relevant tasks in the organization. RDHL, compared with TL, has a better prediction power on CSR and OC. Theoretically, this study implies that the impact of leadership of the organization on OC in the aspects of sustainable development should be going through the influence of the ELB system in the form of CSR to promote the organization's internal and external organizational CSR performance, with added internal strengthening power from OC. Practically, the new RDHL concepts brought up by this study include the training and enhancement of leadership skills based on the content of the scale items being explored. The new RDHL scale contains a comprehensive description of the spirit of the new sustainable era's leadership style. Also, the future applications of RDHL ideas in the form of human resource development should help the realization of the ideally sustainability behavioral patterns of leaders and employees in the organizations. (shrink)

The meshed control theory assumes that cognitive control and automatic processes work together in the natural attention of experts for superior performance. However, the methods adopted by previous studies limit their capacity to provide in-depth information on the neuromotor processes. This experiment tested the theory with an alternative approach. Twelve skilled golfers were recruited to perform a putting task under three conditions: (1) normal condition, with no focus instruction (NC), (2) external focus of attention condition (EC), and (3) internal focus (...) of attention condition (IC). Four blocks of 10 putts each were performed under each condition. The putting success rate and accuracy were measured and electroencephalographies (EEGs) were recorded. The behavioral results showed that the NC produced a higher putting success rate and accuracy than the EC and IC. The EEG data showed that the skilled golfers’ attentional processes in the NC initially resembled those in the EC and then moved toward those in the IC just before putting. This indicates a switch from more automatic processes to cognitive control processes while preparing to putt. The findings offer support for the meshed control theory and indicate the dynamic nature of neuromotor processes for the superior performance of athletes in challenging situations. (shrink)

We investigated whether, in the emergency department, educational video-assisted informed consent is superior to the conventional consent process, to inform trauma patients undergoing surgery about the procedure, benefits, risks, alternatives, and postoperative care. We conducted a prospective randomized controlled trial, with superiority study design. All trauma patients scheduled to receive trauma-related debridement surgery in the ED of Kaohsiung Medical University Hospital were included. Patients were assigned to one of two education protocols. Participants in the intervention group watched an educational video (...) illustrating informed consent information, whereas those in the control group read an informed consent document. The primary outcome was knowledge scores and the secondary outcome was assessment of patient satisfaction. A multivariable regression model, with predefined covariates, was used to analyze differences in knowledge scores and patient satisfaction levels between the groups. A total of 142 patients were enrolled, with 70 and 72 assigned to the intervention and control groups, respectively. Mean knowledge scores were higher in the intervention ) than in the control group. By multivariate analysis, the intervention group had significantly greater differences in knowledge scores. Age, injury severity score, and baseline knowledge score significantly affected the differences in knowledge scores. Significant improvements were observed in patients’ perception of statements addressing comprehension of the information provided, helpfulness of the supplied information for decision making, and satisfaction with the informed consent process. Multivariate analysis showed significant correlations between video education and patient satisfaction. Both the educational approach and severity of injury may have an impact on patient understanding during the informed consent process in an emergency environment. Video-assisted informed consent may improve the understanding of surgery and satisfaction with the informed consent process for trauma patients in the ED. Institutions should develop structured methods and other strategies to better inform trauma patients, facilitate treatment decisions, and improve patient satisfaction. The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (shrink)

Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients’ knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items to forecast (...) outcomes was applied to reach a consensus among the experts. The resulting consensus was used to develop the video content and questions for measuring the understanding of the informed consent for debridement surgery in limb trauma patients. The expert panel included experienced patients. The participants in this pilot study were enrolled as a convenience sample of adult trauma patients scheduled to receive surgery. The modified Delphi technique comprised three rounds over a 4-month period. The items given higher scores by the experts in several categories were chosen for the subsequent rounds until consensus was reached. The experts reached a consensus on each item after the three-round process. The final knowledge measure comprising 10 questions was developed and validated. Thirty eligible trauma patients presenting to the Emergency Department were approached and completed the questionnaires in this pilot study. The participants exhibited significantly higher mean knowledge and satisfaction scores after watching the educational video than before watching the video. Our process is promising for developing procedure-specific informed consent and audiovisual aids in medical and surgical specialties. The educational video was developed using a scientific method that integrated the opinions of different stakeholders, particularly patients. This video is a useful tool for improving the knowledge and satisfaction of trauma patients in the ED. The modified Delphi technique is an effective method for collecting experts’ opinions and reaching a consensus on the content of educational materials for informed consent. Institutions should prioritize patient-centered health care and develop a structured informed consent process to improve the quality of care. The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (shrink)

Background Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients’ knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. Methods A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items (...) to forecast outcomes was applied to reach a consensus among the experts. The resulting consensus was used to develop the video content and questions for measuring the understanding of the informed consent for debridement surgery in limb trauma patients. The expert panel included experienced patients. The participants in this pilot study were enrolled as a convenience sample of adult trauma patients scheduled to receive surgery. Results The modified Delphi technique comprised three rounds over a 4-month period. The items given higher scores by the experts in several categories were chosen for the subsequent rounds until consensus was reached. The experts reached a consensus on each item after the three-round process. The final knowledge measure comprising 10 questions was developed and validated. Thirty eligible trauma patients presenting to the Emergency Department were approached and completed the questionnaires in this pilot study. The participants exhibited significantly higher mean knowledge and satisfaction scores after watching the educational video than before watching the video. Conclusions Our process is promising for developing procedure-specific informed consent and audiovisual aids in medical and surgical specialties. The educational video was developed using a scientific method that integrated the opinions of different stakeholders, particularly patients. This video is a useful tool for improving the knowledge and satisfaction of trauma patients in the ED. The modified Delphi technique is an effective method for collecting experts’ opinions and reaching a consensus on the content of educational materials for informed consent. Institutions should prioritize patient-centered health care and develop a structured informed consent process to improve the quality of care. Trial registration The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (shrink)

Looking closely into how the differences among populations are debated at the ICH, this paper aims to provide a comprehensive account on what actually occurs when states with different cultural backgrounds encounter one another at the frontier of pharmaceutical regulation, where neither West nor East shall exist.

Reflecting on the tension of which he was aware between the imperial West and the still-mysterious East, Victorian writer Rudyard Kipling penned the above phrase to express the incommensurable situation wherein the Westerner never understands the Asian, as the latter’s culture differs too greatly from his own. However, aware that East and West nevertheless cannot remain separated forever, the author ends the poem with an eventual encounter between the two.Over 100 years have passed since this poem was written, yet the (...) ambivalent encounter between East and West that it depicts still exists and is currently playing out within the field of pharmaceuticals. On one side of the divide are the many people in the industry who want to standardize global acceptance of drugs; on the other are the local authorities who want to maintain the overruling legal need not to compromise on health care at a national level. In this sense, the divergence and unity that Kipling captures is what this paper aims to discuss as it addresses how race is debated at the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use. (shrink)

Numerous organizations have faced substantial environmental performance challenges resulting from more than a half-century of worldwide industrialization. Grounded in social learning theory and recourse-based view theory, this study explores environmental performance and its impact on employees and industry outcomes. Drawing on a cross-sectional online survey of 500 full-time employees working in the chemical industry in Lahore, Pakistan. The results revealed a significant positive influence of Green HRM practices on employees’ Green innovation as well as on environmental performance. Additionally, significant influences (...) of study variables were recorded on outcomes such as green compensation and reward, green performance management and appraisal, green training and development, and green recruitment and selection. Several key policy insights related to consumer resistance to innovation in low income societies and future research directions are suggested, along with theoretical and practical implications. (shrink)

Based on 24 hours of videotaped data, this study investigates, both qualitatively and quantitatively, gender differences in the use of person pronouns in televised sports in Taiwan. This analysis has found that, regardless of their speaker role, male sports reporters use the second-person singular pronoun nimuch more frequently than their female counterparts. In addition, there is a significant difference in the distribution ofpragmatic functions of nibetween men’s and women’s reporting. While male sports reporters use niin a more varied way, i.e. (...) to refer to the TV audience, a specific athlete or team, an indefinite or non-specific athlete, or to include this pronoun in direct speech to dramatize their reporting, female reporters use this pronoun predominately to referto a non-specific athlete. In other words, male sports reporters tend to employ impersonal niand dramatic nito signal their strong self-involvement, their interpersonal involvement with the athlete and the TV audience, and their involvement with the reported sports event. Finally, malesports reporters’ more frequent use of the second-person pronoun niin the data also marks their informal and conversational speech style.This result contradicts those previous studies which claim that formality and detachment characterize men’s information-oriented public discourse. (shrink)

Based on video-taped data from five televised 1998 Taipei mayoral debates, this article examines the use of reported speech in Chinese political discourse, with a particular focus on direct quotation. The findings are that direct quotation or constructed dialogue not only creates the rhetorical effect of vividness and immediacy but also establishes interpersonal involvement. More importantly, the three debaters in this study use direct quotation as an indirect strategy for self-promotion and for denigration. Citing someone else's words objectifies debaters' praise (...) of themselves and vilification of their opponents, thereby heightening the reliability of their claims: these claims are presented as shared knowledge and reference is made to an external source. However, direct quotation is also a strategy of evasion: the speakers disclaim responsibility and distance themselves from the source of knowledge. Finally, the different use of citations made by the three debaters also marks their different communicative styles. While the two politicians who speak more formally generally tend to cite figures from newspapers or magazines, the one who speaks most casually frequently employs direct quotations. (shrink)

Adopting Fairclough's multidimensional approach, this corpus-based study explores discursive changes in current Taiwanese society, with a particular focus on conversationalization in printed media. Data were collected from three major newspapers catering to different readerships during three time periods. The analyzed linguistic features include noun phrases, Chinese four-character set expressions, mixing of local dialect, and slang. My analysis shows that over the past two decades there has been an increase of conversational features in all three newspapers. In addition, a cross-sectional comparison (...) has revealed that soft news texts include more conversational features than hard news texts. It is also found that the newspaper which stresses local values and advocates an independent Taiwan identity tends to adopt more conversational features, particularly the mixing of Taiwanese in Mandarin news texts. Finally, I suggest that this trend of conversationalization in the Taiwanese press can be linked to substantive democratization and marketization of the Taiwanese society as well as the change and development of modern written Chinese. (shrink)

One of the interpretive devices that Ch'eng-kuan (澄 觀) is famous for having employed to distill the essence of the vast Mahāvaipulya Buddhāvataṃsaka Sūtra (Tafang-kuang fo-hua-yen ching 《大方廣佛華嚴經》 was a series of variations on the contemplative theme (kuan-men 觀門) of the complete interfusion (yüan-jung 圓融) of the scripture's three chief protagonists (san-sheng 三聖) ── the Buddha Vairocana (Pi-lu-che-na 毘盧遮那) and the bodhisattvas Mañjuśrī (Wen-shu-shih-li 文殊師利) and Samantabhadra (P'u-hsien 普賢). By aligning these three powerful sacred persons with a number of philosophical (...) categories that he believed to be central to the sūtra ── categories like "cause" (yin 因 ), "fruition" (kuo 果 ), "faith" (hsin 信 ), "understanding" (chieh 解), "insight" (chih 智), "practice" (hsing 行), "principle" (li 理), etc. ── he provided a focal point at which the rich and vivid meditative and liturgical lives of Hua-yen devotees could be made to converge with their philosophical reflections. -/- Although Ch'eng-kuan invoked this device in several of his writings, his most concerted development of it is a short essay entitled San-sheng yüan-jung kuan-men, which appears to have been written relatively late in his long career. Like many important Hua-yen texts, this essay seems to have been lost in China not long after its author's death. However, it was preserved in Korea and Japan and from the latter country was reintroduced to China in the last years of nineteenth century. Neither in China nor in the West has it yet been adequately studied. -/- The core of the present article is a critical edition of the Chinese text of the essay based on a careful comparison of all available versions and presented together with a copiously annotated English translation. The edition translation are preceded by a brief interpretive introduction and followed by an appendix in which are given: a detailed discussion of the work's textual history, detailed accounts of its various editions, and descriptions of its several surviving paraphrases and commentaries. (shrink)

Background: To evaluate the effectiveness of a multifaceted intervention in improving emergency department (ED) patient privacy and satisfaction in the crowded ED setting. Methods: A pre- and post-intervention study was conducted. A multifaceted intervention was implemented in a university-affiliated hospital ED. The intervention developed strategies to improve ED patient privacy and satisfaction, including redesigning the ED environment, process management, access control, and staff education and training, and encouraging ethics consultation. The effectiveness of the intervention was evaluated using patient surveys. Eligibility (...) data were collected after the intervention and compared to data collected before the intervention. Differences in patient satisfaction and patient perception of privacy were adjusted for predefined covariates using multivariable ordinal logistic regression. Results: Structured questionnaires were collected with 313 ED patients before the intervention and 341 ED patients after the intervention. There were no important covariate differences, except for treatment area, between the two groups. Significant improvements were observed in patient perception of "personal information overheard by others", being "seen by irrelevant persons", having "unintentionally heard inappropriate conversations from healthcare providers", and experiencing "providers' respect for my privacy". There was significant improvement in patient overall perception of privacy and satisfaction. There were statistically significant correlations between the intervention and patient overall perception of privacy and satisfaction on multivariable analysis. Conclusions: Significant improvements were achieved with an intervention. Patients perceived significantly more privacy and satisfaction in ED care after the intervention. We believe that these improvements were the result of major philosophical, administrative, and operational changes aimed at respecting both patient privacy and satisfaction. (shrink)

Electric-mechanical equipment manufacturing industries focus on the implementation of intelligent manufacturing systems in order to enhance customer services for highly customized machines with high-profit margins such as electric power transformers. Intelligent manufacturing consists in using supply chain data that are integrated for smart decision making during the production life cycle. This research, in cooperation with a large electric power transformer manufacturer, provides an overview of critical intelligent manufacturing technologies. An ontology schema forms the terminology relationships needed to build two intelligent (...) supply chain management modules for the IM system demonstration. The two core modules proposed in this research are the intelligent supplier selection and component ordering module and the product quality prediction module. The intelligent supplier selection and component ordering module dispatches orders that match the best options of suppliers based on combined analytic hierarchy process analysis and multiobjective integer optimization. In the case study, the intelligent supplier selection and component ordering module demonstrates several acceptable Pareto solutions based on strict constraints, which is a very challenging task for decision makers without assistance. The second module is the product quality prediction module which uses multivariate regression and ARIMA to predict the quality of the finished products. Results show that the R square values are very close to 1. The module shortens the time for the company to accurately judge whether the two semifinished iron cores for the product meet the quality requirements. The component supplier selection module and the finished product quality prediction module developed in this research can be extended to other IM systems for general high-end equipment manufacturers using mass customization. (shrink)

The objective of this study is to investigate the effects of emotional labor on job performance and satisfaction, as well as to examine the mediating effect of sleep problems and the moderating effects of personality traits. A time-lagged study was conducted on 864 health professionals. Scales for emotional labor, sleep, personality traits, and job satisfaction were used and job performance data was obtained from records maintained by human resources. Structural equation modeling was performed to investigate the relations. Sleep problems only (...) partially mediated the relationship between surface acting and job satisfaction but completely mediated the relationship between surface acting and job performance. Several personality traits were shown to moderate the relationship between surface acting and sleep problems. The effects were stronger for people with low agreeableness and high neuroticism. The relationship between high levels of deep acting and low levels of sleep problems was more pronounced in individuals with low extraversion. Supervisors should be conscious of emotional labor in the work context and provide necessary deep acting training to facilitate emotional regulation. (shrink)

Working memory performance affects children’s learning. This study examined objective, subjective, and physiological cognitive load while children completed a spatial working memory complex span task. Frist, 80 Taiwanese 11-year-olds who participated in Experiment 1 confirmed the suitability of the materials. Then, 72 Taiwanese 11-year-olds were assigned to high and low complexity groups to participate in Experiment 2 to test the study hypothesis. Children had to recall at the end of a dual-task list and answer two questions regarding the difficulty and (...) mental effort involved in processing and storage. Their pupil diameters were recorded using an eye-tracker. Two-way mixed ANOVA found that the processing requirements and memory load reduced storage and aggravated the subjective CL of storage; the subjective CL of processing was higher under highly complex conditions. Stepwise regression analysis indicated that subjective CL of processing predicted memory performance in low CL conditions, and physiological CL of processing predicted it in high CL conditions. (shrink)

BackgroundThe rating of perceived exertion scales with respiratory and muscular illustrations are recognized as simple and practical methods to understand individual psychometric characteristics in breathing and muscle exertion during exercise. However, the implementation of respiratory and muscular RPE to quantify training load in futsal training camps has not been examined. This study investigates respiratory and muscular RPE relationships during domestic training camps and overseas training camps in an under 20 futsal national team.MethodsData collected from eleven field players were used for (...) comparison in this study. All players reported Borg CR10 RPE and 7-scales respiratory RPE and muscular RPE after training sessions and matches. Additionally, total distance covered and training impulse were used to quantify external and internal loads via the Polar Team Pro system. Paired-sample t-tests were used to compare the RPECR10, RPErespiration, RPEmuscle, TD, and TRIMP between DTC and OTC. Furthermore, linear regression was performed to determine the relationships among all RPE scales, TD, and TRIMP.ResultsThe RPECR10, TD, and TRIMP showed significant difference between DTC and OTC. Furthermore, linear regression analyses showed significant correlation between RPErespiration and RPEmuscle, RPECR10 and RPErespiration, and RPECR10 and RPEmuscle.ConclusionPictorial RPErespiration or RPEmuscle can be used as an alternative to quantify perceived measures of internal loads during DTC and OTC in futsal players. Interpretation of perceived measures of training load and cardiac-related responses in association with external training loads during short-term training camps would be useful in further understanding the demands of futsal players’ experience in these circumstances. (shrink)

Hua-yen is regarded as the highest form of Buddhism by most modern Japanese and Chinese scholars. This book is a description and analysis of the Chinese form of Buddhism called Hua-yen, Flower Ornament, based largely on one of the more systematic treatises of its third patriarch. Hua-yen Buddhism strongly resembles Whitehead's process philosophy, and has strong implications for modern philosophy and religion. Hua-yen Buddhism explores the philosophical system of Hua-yen in greater detail than does Garma C.C. Chang's _The Buddhist Teaching (...) of Totality _. An additional value is the development of the questions of ethics and history. Thus, Professor Cook presents a valuable sequel to Professor Chang's pioneering work. The Flower Ornament School was developed in China in the late 7th and early 8th centuries as an innovative interpretation of Indian Buddhist doctrines in the light of indigenous Chinese presuppositions, chiefly Taoist. Hua-yen is a cosmic ecology, which views all existence as an organic unity, so it has an obvious appeal to the modern individual, both students and layman. (shrink)

This essay attempts a paradigmatic comparison between the fourfold worldview of Hua-yen Buddhism and the postmodern philosophy of Jean-François Lyotard. Employing a tension between centripetal and centrifugal forces as a structural underpinning of these two philosophies, the essay illuminates the liberating nature of Hua-yen Buddhism and postmodern thought together with the shadow of skepticism involved in endorsing a vision for a poly-lingual existence. Despite human beings' desire for a totalitarian vision hidden in every aspect of our discourse, Hua-yen Buddhism and (...) postmodern thought demand us to envision the world of the 'inconceivable' in which the diversity of existence raises its own voice beyond the regulating force of our society. (shrink)

Abbreviations Works by Alfred North Whitehead 1) Adventures of Ideas. New York: Macmillan Co., 1967 AI 2) Concept of Nature. Cambridge: Cambridge University Press, 1971 CN 3) Modes of Thought. New York: Macmillan Co., 1968 MT 4) Process ..