BackgroundAlthough the Life-Sustaining Treatment (LST) Decision Act was enforced in 2018 in Korea, data on whether it is well established in actual clinical settings are limited. Hospital-acquired pneumonia (HAP) is a common nosocomial infection with high mortality. However, there are limited data on the end-of-life (EOL) decision of patients with HAP. Therefore, we aimed to examine clinical characteristics and outcomes according to the EOL decision for patients with HAP.MethodsThis multicenter study enrolled patients with HAP at 16 referral hospitals retrospectively from (...) January to December 2019. EOL decisions included do-not-resuscitate (DNR), withholding of LST, and withdrawal of LST. Descriptive and Kaplan–Meier curve analyses for survival were performed.ResultsOf 1,131 patients with HAP, 283 deceased patients with EOL decisions (105 cases of DNR, 108 cases of withholding of LST, and 70 cases of withdrawal of LST) were analyzed. The median age was 74 (IQR 63–81) years. The prevalence of solid malignant tumors was high (32.4% vs. 46.3% vs. 54.3%, P = 0.011), and the ICU admission rate was lower (42.9% vs. 35.2% vs. 24.3%, P = 0.042) in the withdrawal group. The prevalence of multidrug-resistant pathogens, impaired consciousness, and cough was significantly lower in the withdrawal group. Kaplan–Meier curve analysis revealed that 30-day and 60-day survival rates were higher in the withdrawal group than in the DNR and withholding groups (log-rank P = 0.021 and 0.018). The survival of the withdrawal group was markedly decreased after 40 days; thus, the withdrawal decision was made around this time. Among patients aged below 80 years, the rates of EOL decisions were not different (P = 0.430); however, mong patients aged over 80 years, the rate of withdrawal was significantly lower than that of DNR and withholding (P = 0.001).ConclusionsAfter the LST Decision Act was enforced in Korea, a DNR order was still common in EOL decisions. Baseline characteristics and outcomes were similar between the DNR and withholding groups; however, differences were observed in the withdrawal group. Withdrawal decisions seemed to be made at the late stage of dying. Therefore, advance care planning for patients with HAP is needed. (shrink)

While social interaction and play in a VR environment are becoming ever more popular, little is known about how social VR games affect users. The purpose of this study was to elucidate the role of several contingent factors in social VR games by modeling the relationships between involvement, well-being, depression, self-esteem, and social connectedness. A conditional process-moderated mediation model of the measured variables was analyzed with 220 pieces of collected data. The result showed that: the direct effect of involvement on (...) well-being was significant, and the index of moderated mediation involving depression, self-esteem, and social connectedness was significant. We conclude that high levels of involvement in social VR games by socially isolated users with low self-esteem can negatively affect their well-being. The findings of this study contribute in several ways to our understanding of the effect of social VR games upon users and provide important practical implications. (shrink)

Jonathan Edwards was a preacher, theologian, and missionary to the Native Americans. This book asserts that Jonathan Edwards stood firmly on the Reformed tradition in the doctrine of justification.

Does the Ship of Theseus present a genuine puzzle about persistence due to conflicting intuitions based on “continuity of form” and “continuity of matter” pulling in opposite directions? Philosophers are divided. Some claim that it presents a genuine puzzle but disagree over whether there is a solution. Others claim that there is no puzzle at all since the case has an obvious solution. To assess these proposals, we conducted a cross-cultural study involving nearly 3,000 people across twenty-two countries, speaking eighteen (...) different languages. Our results speak against the proposal that there is no puzzle at all and against the proposal that there is a puzzle but one that has no solution. Our results suggest that there are two criteria—“continuity of form” and “continuity of matter”— that constitute our concept of persistence and these two criteria receive different weightings in settling matters concerning persistence. (shrink)

BackgroundExperience with open disclosure and its study are restricted to certain western countries. In addition, there are concerns that open disclosure may be less suitable in non-western countries. The present study explored and compared the in-depth perceptions of the general public and physicians regarding open disclosure in Korea.MethodsWe applied the COREQ checklist to this qualitative study. We conducted 20 in-depth interviews and four focus group discussions with 16 physicians and 18 members of the general public. In-depth interviews and focus group (...) discussions were performed according to semi-structured guidelines developed according to a systematic review of open disclosure. We conducted a directed content analysis by analyzing the verbatim transcripts and field notes in accordance with the predetermined guidelines.ResultsOpen disclosure perceptions were summarized in terms of the “five Ws and one H”. All physician and general public participants acknowledged the normative justifiability of open disclosure. The participants mostly agreed on the known effects of open disclosure, but the physicians had negative opinions on its expected effects, such as decreased intention of the general public to file lawsuits and increased credibility of medical professionals. Generally, the participants thought that open disclosure is required for medical errors causing major harm. However, the physicians and general public had conflicting opinions on the need for open disclosure of near misses. Most physicians did not know how to conduct open disclosure and some physicians had bad experiences due to inappropriate or incomplete open disclosure.ConclusionPhysicians and the general public in Korea acknowledge the need for open disclosure. Guidelines according to the type of patient safety incident are required to encourage physicians to more readily conduct open disclosure. Furthermore, hospitals need to consider organizing a dedicated team and hiring experts for open disclosure. (shrink)

Background Nurses providing care to patients with end-of-life or terminal illnesses often encounter ethically challenging situations leading to moral distress. However, existing quantitative studies have examined moral distress using instruments that address general clinical situations rather than those specific to end-of-life care. Furthermore, qualitative studies have often been limited to participants from a single unit or those experiencing moral distress-induced circumstances. A comprehensive and integrated understanding of the overarching process of moral distress is vital to discern the unique circumstances surrounding (...) end-of-life care and its consequential impacts. Research objectives To explore the moral distress experiences of nurses who are frequently involved in caring for patients with end-of-life or terminal illnesses and apply it to two existing theories: the model of moral distress and the ecological model. Research design A qualitative descriptive approach was employed. Participants and research context Seven focus group interviews involving 30 nurses were performed. The subsequent transcriptions underwent rigorous content analysis. Ethical considerations We obtained Institutional Review Board approval from a university. Focus group interviews were conducted with nurses who agreed to participate and signed the consent form. Findings The moral distress-inducing factors and nurses’ perceived impact of moral distress were identified and categorized based on moral distress theories and ecological models. A total of 15 categories and 30 subcategories across the following 4 domains were derived: (1) intrapersonal, (2) interpersonal, (3) organizational, and (4) structural factors. Conclusions End-of-life-specific circumstances induced moral distress among nurses, with both negative and positive impacts identified. Effective organizational and policy support is essential to manage conflicts, form a healthy organizational culture, provide training, and prevent unnecessary expenses due to the negative consequences of moral distress. (shrink)

How can corporate social responsibility initiatives influence brand love? Based on the theory of social identity complexity, we examined whether greater complexity of a sport fan’s multiple identifications with sport leagues led to higher multicultural tolerance and more positive perceptions of leagues’ corporate social responsibility activities. Further, brand authenticity was tested as a variable intervening between perceived corporate social responsibility and brand love. We analyzed this serial mediation effect impacting sport fans’ brand love for their multiple, favored and less favored, (...) sport leagues. Participants answered the scale item questionnaire for model assessment. The hypothesized model was supported as the indirect effect through all mediators was significant. Our results suggest that when sport fans acknowledge a high overlap among league fan groups, their tolerance is more likely to be higher than those who have a low overlap. Such high levels of tolerance influence how fans perceive corporate social responsibility initiatives, and these effects build up for fans to perceive the brand to be more authentic. These antecedents affected brand love through a serial mediation. Sport league managers should consider the diverse aspects across leagues for harmonious coexistence with other leagues and maintain brand authenticity for their social initiatives to result in a greater brand love in the consumer’s mind. (shrink)

How can sport community involvement influence life satisfaction during a pandemic? Self-expansion theory posits that individuals seek to gain resources such as positive interpersonal relationships for growth and achievement. By considering psychological capital as a dispositional resource intervening between sport community involvement and life satisfaction, we examined an empirical model to test the chain of effects. Based on the stress process model, distress and generational group were tested as moderators. Participants responded to the scale item questionnaire for model assessment. Supporting (...) the hypothesized relationships, the model was supported with a significant moderated-moderated mediation. The mediation effect of PsyCap was stronger when distress level was lower and such interaction effect was amplified for Generation Z. Whereas the global sport communities and Gen Z were found to be more particularly vulnerable to COVID-19, our findings suggest that there are psychological pathways for fans to maintain their resilience. It is foremost imperative to lower the stress level of sport fans for their community involvement to positively affect life satisfaction. Gen Z were more stressed during the pandemic but individuals who managed to cope with stress were able to leverage community involvement to boost positive psychological resources. Acknowledgment of these effects brings implications for better management strategies and provides avenues for new research. (shrink)

The notion of ‘wise mother and good wife (WMGW)’ (Hyonmo Yangcho) is the traditional idealized image of Korean womanhood as one who serves her country and others through her roles as a mother and wife. This ideology may continue to have some significance in the lives of many first‐generation Korean immigrant women, but its potential role in the adjustment challenges these women may face while acculturating to the immigrant context in the United States has received little attention. In this paper, (...) we briefly review the historical background of the WMGW ideology and discussed the significance of focusing research attention on the role of this notion in contemporary first‐generation Korean immigrant women in the United States. We focus on the intersecting influences of gender, ethnicity, and immigrants’ generation status, which may further marginalize some first‐generation Korean immigrant mothers. We then outline possible unique challenges faced by some of these mothers due to the WMGW gender ideology, highlighting potential immigration‐related difficulties including changes in their social support networks, parenting burden, mental health, and language issues. Finally, we provide suggestions for researchers and practitioners working with U.S. Korean immigrant women. (shrink)

An incoherent feed‐forward loop (FFL) is one of the most‐frequently observed motifs in biomolecular regulatory networks. It has been thought that the incoherent FFL is designed simply to induce a transient response shaped by a ‘fast activation and delayed inhibition’. We find that the dynamics of various incoherent FFLs can be further classified into two types: time‐dependent biphasic responses and dose‐dependent biphasic responses. Why do the structurally identical incoherent FFLs play such different dynamical roles? Through computational studies, we show that (...) the dynamics of the two types of incoherent FFLs are mutually exclusive. Following from further computational results and experimental observations, we hypothesize that incoherent FFLs have been optimally designed to achieve distinct biological function arising from different cellular contexts. Additional Supporting Information may be found in the online version of the article. BioEssays 30:1204–1211, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

Cover Photograph: Resolving developmental genetics in the fourth dimension: an illustration (by Kwang‐Hyun Cho himself) of the principle of dynamic network motifs in Drosophila development. Hitherto largely considered in terms of time‐invariant networks, drosophila development is viewed in the article by Man‐Sun Kim, Jeong‐Rae Kim, and Kwang‐Hyun Cho as the result of networks of gene interactions that change during the course of development. Using this paradigm, pivotal developmental events can be correlated with particular changes from one constellation of (...) gene interactions to a different one, and the method allows the identification of certain network motifs that are not identifiable using static approaches. Features article: “Dynamic network rewiring determines temporal regulatory functions in the Drosophila melanogaster development processes”, see pages 505 – 513. (shrink)

The identification of network motifs has been widely considered as a significant step towards uncovering the design principles of biomolecular regulatory networks. To date, time‐invariant networks have been considered. However, such approaches cannot be used to reveal time‐specific biological traits due to the dynamic nature of biological systems, and hence may not be applicable to development, where temporal regulation of gene expression is an indispensable characteristic. We propose a concept of a “temporal sequence of network motifs”, a sequence of network (...) motifs in active sub‐networks constructed over time, and investigate significant network motifs in the active temporal sub‐networks of Drosophila melanogaster. Based on this concept, we find a temporal sequence of network motifs which changes according to developmental stages and thereby cannot be identified from the whole static network. Moreover, we show that the temporal sequence of network motifs corresponding to each developmental stage can be used to describe pivotal developmental events. (shrink)

Cellular circuits have positive and negative feedback loops that allow them to respond properly to noisy external stimuli. It is intriguing that such feedback loops exist in many cases in a particular form of coupled positive and negative feedback loops with different time delays. As a result of our mathematical simulations and investigations into various experimental evidences, we found that such coupled feedback circuits can rapidly turn on a reaction to a proper stimulus, robustly maintain its status, and immediately turn (...) off the reaction when the stimulus disappears. In other words, coupled feedback loops enable cellular systems to produce perfect responses to noisy stimuli with respect to signal duration and amplitude. This suggests that coupled positive and negative feedback loops form essential signal transduction motifs in cellular signaling systems. BioEssays 29: 85–90, 2007. © 2006 Wiley Periodicals, Inc. (shrink)

The result of 2007’s presidential election in South Korea symbolizes the decline of the Left and the growth of the new Right. They say it goes with the global retrogression of democracy, or the consolidation of the hegemony of the rightist versions of democracy. According to Choi Jang-jip, the general public in Korea has thought that the Roh Moo-hyun’s administration had betrayed them, handing power over to the market, and seeking to form a coalition government with theconservatives. Similarly, Professor (...) Jang Ha-jun asserts that the democratic governments of Kim Dae-jung and Roh Moo-hyun have mistaken economic democratization for neo-liberalistic structural adjustment. (shrink)

This chapter introduces several distinctions relevant to what is called the “discounting problem”, since the issue is how (future) costs and benefits are discounted to make them comparable in present terms. The author defends the claim that there are good reasons to adopt Ramsey-style discounting in the context of climate change: the Ramsey rule is robust, flexible, and well-understood. An important distinction involved in discounting—“descriptivism” and “prescriptivism”—is discussed. It is argued that, even if we adopt prescriptivism, and accept that this (...) means there is need for moral experts in parameter assignments, there is a significant issue. The type of moral expertise required for the discounting problem will not involve knowledge of moral theory—thus making moral philosophy unhelpful in terms of making particular parameter assignments, despite these being substantive moral judgments. (shrink)

This study examines the challenges of humanism and education in the 21st century as addressed by the German philosopher Peter Sloterdijk in his Elmau Speech (1999). In this lecture, titled _Rules for the Human Zoo_, Sloterdijk argues that the traditional notion of humanism, specifically “humanism as a literary society,” has reached its conclusion, necessitating the development of a new humanism appropriate for the contemporary era. However, the new concept of humanism emerging from what Sloterdijk terms the “anthropotechnic turn” appears to (...) align with the discourses surrounding human enhancement that have emerged in the 21st century, thereby influencing the realm of education. The first half of this article reports on the significant concerns and criticisms expressed by the media at that time regarding this new humanism, which seems to be associated with eugenicist ideas. Taking a step further, this study critically examines the nature of the challenges around education implied by Sloterdijk, specifically the conflict between “friend of humans and friend of Übermensch”, and explores the potential roles and responsibilities of education in the latter part of the paper. (shrink)

While mitigation and adaptation will help to protect us from climate change, there are harms that are beyond our ability to adapt. Some of these harms, which may have been instigated from historical emissions, plausibly give rise to duties of compensation. This chapter discusses several principles that have been discussed about how to divide climate duties—the polluter pays principle, the beneficiary pays principle, the ability to pay principle, and a new one, the polluter pays, then receives principle. The chapter introduces (...) several challenges to these principles from the literature, before discussing which policies and institutions might be relevant to compensation, whether internationally (e.g. the Green Climate Fund) or intergenerationally (e.g. Broome and Foley’s World Climate Bank). It also describes some recent successful climate cases which require both the Dutch government and a private firm to act in accordance with climate targets to avoid potential rights-violations. Finally, it discusses one of the most important international concepts with respect to compensation: the Loss & Damage pillar of climate policy. (shrink)

The two mythical tales from the Samguk yusa, “Lady Suro” and “Monk Hyet’ong Defeats the Dragon” reveal the little-known evil character of the Korean dragons. The second story presents a particular scene of a confrontation between a hero and a malicious dragon; this story leads us to reflect on the question of the symbolism of evil embodied by the Dragon who has a vengeful character. The dragon symbol and its semantic variations were constructed specifically within the singular Korean context and (...) cannot be limited to Chinese Buddhist heritage. (shrink)

It is a hallmark of a good model to make accurate a priori predictions to new conditions (Busemeyer & Wang, 2000). This study compared 8 decision learning models with respect to their generalizability. Participants performed 2 tasks (the Iowa Gambling Task and the Soochow Gambling Task), and each model made a priori predictions by estimating the parameters for each participant from 1 task and using those same parameters to predict on the other task. Three methods were used to evaluate the (...) models at the individual level of analysis. The first method used a post hoc fit criterion, the second method used a generalization criterion for short‐term predictions, and the third method again used a generalization criterion for long‐term predictions. The results suggest that the models with the prospect utility function can make generalizable predictions to new conditions, and different learning models are needed for making short‐versus long‐term predictions on simple gambling tasks. (shrink)

In the first half, I suggest that Kant’s conception of our moral life goes through a significant shift after 1793, with reverberations in his eschatology. The earlier account, based on the postulate of immortality, describes our moral life as an endless pursuit of the highest good, but all this changes in the later account, and I point out three possible reasons for this change of heart. In the second half, I explore how the considerations Kant brings up to argue for (...) his accounts can inform our process of formulating positions with respect to the afterlife. I argue that, in the absence of a convincing theoretical proof for or against the afterlife as well as apodictically certain knowledge of how demanding the moral law is, the Kantian strategy would be to ask which account of our moral life delivers the kind of contentment that can sustain our moral resolve. I also point out a way theists might be able to find contentment despite their moral failures by imagining God’s moral kenosis. (shrink)

The current consensus is that most natural categories are not organized around strict definitions (a list of singly necessary and jointly sufficient features) but rather according to a family resemblance (FR) principle: Objects belong to the same category because they are similar to each other and dissimilar to objects in contrast categories. A number of computational models of category construction have been developed to provide an account of how and why people create FR categories (Anderson, 1990; Fisher, 1987). Surprisingly, however, (...) only a few experiments on category construction or free sorting have been run and they suggest that people do not sort examples by the FR principle. We report several new experiments and a two‐stage model for category construction. This model is contrasted with a variety of other models with respect to their ability to account for when FR sorting will and will not occur. The experiments serve to identify one basis for FR sorting and to support the two‐stage model. The distinctive property of the two‐stage model is that it assumes that people impose more structure than the examples support in the first stage and that the second stage adjusts for this difference between preferred and perceived structure. We speculate that people do not simply assimilate probabilistic structures but rather organize them in terms of discrete structures plus noise. (shrink)

Ideal carbon tax policy is internationally coordinated, fully internalizes externalities, redistributes revenues to those harmed, and is politically acceptable, generating predictable market signals. Since nonideal circumstances rarely allow all these conditions to be met, moral issues arise. This paper surveys some of the work in moral philosophy responding to several of these issues. First, it discusses the moral drivers for estimates of the social cost of carbon. Second, it explains how national self-interest can block climate action and suggests international policies—carbon (...) border tax adjustments and carbon clubs—that can help address these concerns. Third, it introduces some of the social science literature about the political acceptability of carbon taxes before addressing a couple common public concerns about carbon taxes. Finally, it introduces four carbon revenue usage options, arguing that redistributive and climate compensation measures are most morally justified. [Open access]. (shrink)