PurposeThis study aims to develop and validate a stigma scale for Chinese patients with breast cancer.MethodsPatients admitted to the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, for breast cancer treatment participated in this study. Development of the Breast Cancer Stigma Scale involved the following procedures: literature review, interview, and applying a theoretical model to generate items; the Breast Cancer Stigma Scale’s content validity was assessed by a Delphi study and feedback from patients with breast cancer ; (...) exploratory factor analysis was used to assess the construct validity; convergent validity was assessed with the Social Impact Scale ; internal consistency Cronbach’s α, split-half reliability, and test–retest reliability were used to identify the reliability of the scale.ResultsThe final version of the Breast Cancer Stigma Scale consisted of 15 items and showed positive correlations with the Social Impact Scale. Exploratory factor analysis revealed four components of the Breast Cancer Stigma Scale: self-image impairment, social isolation, discrimination, and internalized stigma, which were strongly related to our perceived breast cancer stigma model and accounted for 69.443% of the total variance. Cronbach’s α for the total scale was 0.86, and each subscale was 0.75–0.882. The test–retest reliability with intra-class correlation coefficients of the total scale was 0.947, and split-half reliability with intra-class correlation coefficients of the total scale was 0.911. The content validity index was 0.73–1.0.ConclusionThe newly developed Breast Cancer Stigma Scale offers a valid and reliable instrument for assessing the perceived stigma of patients with breast cancer in clinical and research settings. It may be helpful for stigma prevention in China. (shrink)

ObjectivesA sample of women with persistent distress following breast cancer previously exhibited attentional bias away from supraliminally presented cancer-or threat-related information, responses consistent with avoidance coping, and showed negative interpretation bias. Here, we attempt to characterize the nature of supraliminal AB and interpretation bias in that sample of women by comparing against healthy controls.MethodsExtending our previous work, we compared AB patterns for supraliminally presented negatively valenced words and cancer-related information assessed by modified dot-probe tasks and negative interpretation bias assessed by (...) an ambiguous cue task between 140 BC women previously identified as featuring low-stable or persistent high anxiety and 150 age-matched non-BC healthy controls having HADS-defined low or high anxiety.ResultsAttentional avoidance of non-cancer-related negatively valenced words was seen among the anxious BC group, while heightened attention toward such words was seen in anxious healthy controls, F = 3.97, p = 0.009. However, all anxious women in both BC and healthy groups directed attention away from CRI under supraliminal conditions. Interpretation bias scores were significantly higher in BC women with high anxiety vs. healthy controls with high anxiety, F = 13.26, p < 0.001.ConclusionWomen with high anxiety generalized conscious attentional avoidance responses to negatively valenced stimuli, indicating a likely hypersensitivity to potential threat in ambiguous cues and exaggerated threat perception. This may cause maladaptive emotional regulation. Attention focus training, reducing threat salience or modifying threat appraisal, may help women alleviate anxiety levels after BC. (shrink)

Pessimism over a democracy’s ability to produce good outcomes is as longstanding as democracy itself. On one hand, democratic theorists consider democracy to be the only legitimate form of government on the basis that it alone promotes or safeguards intrinsic values like freedom, equality, and justice. On the other, skepticism toward the ordinary citizen’s cognitive capacities remains a perennial concern. Qualms about the epistemic value of democracy have only been made more pertinent by a fundamental problem of deep epistemic disagreement (...) which underlies the post-truth phenomenon. I argue that the democratic theorists who have sought to defend democracy on epistemic grounds have thus far neglected such deep and intractable disagreements. Without addressing this oversight, the epistemic democrat will find that collective decision-making processes quickly become paralyzed and will not be able to yield the epistemic benefits they promise. Hence, the work for epistemic democrats is to recognize and take into account the ramifications of epistemic disagreements so as to make a stronger case for epistemic democracy. (shrink)

Background: Ethical issues related to comparative effectiveness research, or research that compares existing standards of care, have recently received considerable attention. In this paper we focus on how Ethics Review Committees should evaluate the risks of comparative effectiveness research. Main text: We discuss what has been a prominent focus in the debate about comparative effectiveness research, namely that it is justified when “nothing is known” about the comparative effectiveness of the available alternatives. We argue that this focus may be misleading. (...) Rather, we should focus on the fact that some experts believe that the evidence points in favor of one intervention, whereas other experts believe that the evidence favors the alternative. We will then introduce a case that illustrates this point, and based on that, discuss how ERCs should deal with such cases of expert disagreement. Conclusion: We argue that ERCs have a duty to assess the range of expert opinions and based on that assessment arrive at a risk judgment about the study under consideration. We also argue that assessment of expert disagreement is important for the assignment of risk level to a clinical trial: what is the basis for expert opinions, how strong is the evidence appealed to by various experts, and how can clinical trial monitoring affect the possible increased risk of clinical trial participation. (shrink)

In summary, the discussion by Professors Helmchen and Müller-Oerlinghausen of the morality of clinical trials has emphasized a point that is frequently overlooked. It is an essential to consider those situations in which it might be unethical not to conduct a trial as it is to be concerned about the ways in which trials might restrict the rights of the individuals taking part in them. They and I have dealt mainly with the first of these two issues because it has (...) been relatively neglected. The second is, of course, equally important and has rightly received much attention. Both matters deserve further public discussion. (shrink)

Adaptation to climate change impacts is a key research topic in business ethics that poses substantial implications on the good lives of human beings. The commercial port sector is a highly relevant study focus with its pivotal roles in supply chains and international trade. Hence, it is important to investigate whether the port planning system and practice is appropriate in tackling climate change impacts. But beforehand, we must thoroughly understand the attitude and behaviors of port planners and operators on ports’ (...) climate adaptation planning. Through a survey towards 21 ports in Canada, the paper investigates the attitude and behaviors of port planners and operators on ports’ climate adaptation planning. Towards the end, we propose a new approach so as to enable port stakeholders to carry out climate adaptation planning effectively. The paper offers important insight to researchers to investigate the ways in developing effective climate adaptation plans and practice for ports and other business sectors. (shrink)

The WHO Consultative Group on Equity and Universal Health Coverage published a comprehensive report titled “Making Fair Choices on the Path to Universal Health Coverage” detailing strategies that countries should adopt when moving towards providing healthcare coverage to the entire population. The report provides detailed guidelines on how to expand coverage to more people, what services should be covered, and how to prioritize these healthcare resources in achieving universal healthcare coverage. The main goal of this WHO report is to ensure (...) fair and equitable access for all population groups within a country during the implementation of UHC. In principle, the group’s approach is sound and fair, but we argue that each country must take into account its own unique situations in designing a pathway towards UHC. China has achieved near UHC but did so by an approach that would have been deemed completely unacceptable based on this group’s recommendations. In this article, we provide a brief review of the Chinese healthcare system and argue that the implementation of the recommendations in the report is not always feasible. We argue that there are alternate pathways towards achieving UHC and there are good reasons for China’s departure from the approach outlined by the WHO report. Nevertheless, we acknowledge substantial inequities still exist for various segments of the population and among the diverse areas of China in accessing healthcare services and make suggestions on how to reduce such inequities within the system. (shrink)

This paper examines the effects of environmental factors on the ethical behavior of managers using computers at work in Mainland China. In this study, environmental factors refer to senior management, peer groups, company policies, professional practices, and legal considerations. Ethical behaviors include attitudes to disclosure, protection of privacy, conflict of interest, personal conduct, social responsibility, and integrity. A questionnaire survey was used for data collection, and 125 mainland Chinese managers participated in the study. The results show that peer groups, professional (...) practices, and legal considerations do influence the ethical behavior of mainland Chinese managers in the areas of social responsibility, integrity, and accountability. A discussion of the implications of the results is also provided in this paper. (shrink)

ObjectivesWorking-age cancer patients face barriers to resuming work after treatment completion. Those resuming work contend with reduced productivity arising from persisting residual symptoms. Existing studies of return to work after cancer diagnosis were done predominantly in Western countries. Given that employment and RTW in cancer survivors likely vary regionally due to healthcare provision and social security differences, we documented rates and correlates of RTW, work productivity, and activity impairment among Chinese cancer survivors in Hong Kong at one-year post-treatment.MethodsOf 1,106 cancer (...) patients assessed at six-months post-cancer treatment, 593 previously worked; detailed work status, psychological distress, physical symptom distress, supportive care needs, health-related quality of life, and illness perception were assessed. Six months later, work productivity and activity impairment were assessed. Descriptive analyses examined RTW rate. Fully adjusted regressions determined RTW, work productivity, and activity impairment predictors.ResultsAt baseline, 39% were working, 26% on sick leave, and 35% were unemployed. Compared to patients returning to work, unemployed participants were older, likely manual/service-oriented workers, and had lower family income, chemotherapy, fewer unmet health system and information needs, poorer physical functioning, and negative illness perceptions. Sick leave participants were likely service-oriented workers, who had head and neck cancer, chemotherapy, and poor physical functioning. At FU, baseline depressive symptoms, physical symptom distress, and negative illness perceptions predicted presenteeism and work productivity loss; gynecological cancer, fewer unmet health system and information needs, and greater unmet sexuality needs predicted absenteeism; physical symptom distress, negative illness perception, and poor physical functioning predicted activity impairment.ConclusionCancer survivors who had more physically demanding jobs and poorer physical functioning delayed RTW. Unmanaged physical symptom and psychological distress hindered work productivity. (shrink)

The race among global firms to launch its respective products and services into the market sooner than the competitors puts pressure to equip its employees with job-related skills at the pace of business. Today’s global and dynamic business requires employees to develop highly complex cognitive skills such as decision-making, problem-solving, troubleshooting to perform their jobs proficiently. Traditional training models used by some organizations lead to a very slow speed at which employees gain an acceptable level of proficiency in the targeted (...) job skills. Also, these models have long and regimented instructional development cycle. Thus, traditional models are inherently counter-productive to the business and do not enable employees and organizations for today’s business needs. Therefore, business organizations need to explore new training models and strategies that could reduce the time an employee takes to reach target proficiency in complex skills without compromising the effectiveness or outcome. A comprehensive review of the literature shows a very limited amount of academic or practitioner research on this topic. This doctorate research study aims to find various training strategies that have proven successful in organizations for accelerating proficiency of employees in complex job skills. The researcher collected data primarily through 74 in-depth interviews with 86 training experts with known work experience of reducing time-to-proficiency in various settings. A total of 105 project cases have been collected across 42 industries to date. A grounded theory approach with constant comparison method is used to guide the theoretical saturation, analyze the data and to develop a theoretical model of training strategies. This unique study revealed a range of training strategies from non-training solutions to classroom instructions to workplace training to accelerate proficiency of employees in acquiring complex skills. This paper will specifically report the preliminary findings and conceptual model of major classroom-based instructional strategies only that has been found to hold the potential to shorten time-to-proficiency of employees at the workplace. This paper will also discuss the implications of the findings for the practitioners. Results in this study confirmed that classroom-based instructional strategies need to be designed and delivered the way the work is being performed in reality by the learners. Research findings suggest a pattern of five classroom-based instructional strategies that are more successful in reducing time-to-proficiency - 1) Contextualized learning 2) Performance analysis of star performer 3) Active processing and emotional involvement 4) Access to self-guided learning resources 5) Social interconnectivity and informal learning. (shrink)

Globalized workplace is increasingly moving into complex jobs requiring their employees to exhibit complex knowledge and complex skills. Though acquiring such complex skills or knowledge requires longer time, the pace of business puts pressure on organizations to accelerate the time it takes for their employees to become proficient in their jobs. This shift has challenged the conventional training and learning strategies, structure, methods, instructional design and delivery methodologies generally used by training providers and by the organizations. This paper presents the (...) preliminary research findings of a Doctorate research carried out using Grounded theory approach with over 71 in-depth interviews with leading experts in over 40 industries. Preliminary findings suggest that certain e-learning strategies and platforms hold better potential over others to successfully accelerate time-to-proficiency of individuals in leading organizations. This paper provides first look at 10 e-learning strategies and how those could be orchestrated before, during and after a formal training program to develop job-ready learners in shorter time. (shrink)

The high pace business environment poses great competition among firms. The key to an organisation’s survival is its workforce. Time taken by the workforce to reach to full proficiency in their job role takes very long in certain job roles. Thus, shortening time-to-proficiency of employees is a critical business problem for today’s organisations. This qualitative research study explored the proven practices and strategies that have successfully reduced time-to-proficiency of the workforce in various settings. A total of 93 participants from seven (...) countries participated in the research study. Bounded project case was used as sampling unit and unit of analysis in this study. This study collected 67 successful project cases with the evidence of significant reduction in time-to-proficiency of the workforce in their settings. These project cases spanned across nine economic sectors, 20 business sectors and 28 industry groups. This study revealed that project leaders across the board used six practices to successfully reduced the time-to-proficiency. The purpose of this paper is present the model of accelerated proficiency at the workplace developed in this study. (shrink)

In 1990, the Federal Trade Commission (FTC) issued a consent order to the American Institute of Certified Public Accountants (AICPA). The order decreed the AICPA to lessen its longstanding ethics code which had until then banned the receipts of commissions, referral fees and contingent fees. The FTC alleged that the AICPA banned receipt of the fees as an attempt to restrain trade (FTC, 1990).In the present study, we sought to determine if CPAs'' preference for bans on commissions, referral fees and (...) contingent fees is related to their moral reasoning whereby CPAs perceive the bans to serve as a means of resolving ethical issues. While determining this matter cannot prove whether the bans did or did not actually result in restrained trade, it can offer insight into the perceived ethical importance to CPAs of the overturned rules. Based on a random sample of AICPA members and using Rest''s Defining Issues Test (DIT) to measure moral reasoning, we did not find a CPA''s moral reasoning to be related to his/her preference for ethics rules which ban commissions, referral fees or contingent fees. However, our results did indicate that most CPAs prefer banning commissions, referral fees and contingent fees, with those CPAs holding a higher financial stake in public accounting, namely partners, favoring banning referral fees and contingent fees significantly less than CPAs with a lesser stake. Further, we noted a significant negative relationship between financial stake and moral reasoning. These results seem to suggest that self-interest among CPAs may influence their moral reasoning.Further study is needed to examine the relationship between self-interest of CPAs and their moral reasoning. If self-interest clouds moral judgments made by CPAs, capital markets are in danger. Rendering an independent audit opinion must exclude self-interest. (shrink)

This book is a collection of articles on different aspects of university education in China since the late nineteenth century, addressing how far the ideal of modern university education, which has gradually been developed in the West since the age of European Enlightenment, was adopted or transformed by Chinese universities.