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)

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)

We used functional magnetic resonance imaging to examine the interactive effects of perceived competence and task interest on the cognitive and affective responses to negative feedback. Twenty-four undergraduates performed both interesting and uninteresting tasks and received failure feedback. The participants’ perceived competence in the task was manipulated between subjects prior to scanning with bogus feedback. The results showed that negative feedback processing was contingent upon both perceived competence and task interest. The most adaptive coping mechanism, indicated by activation in the (...) cognitive control network and attenuation in the negative affect region, was identified for the high-competence and high-interest combination. When either competence or interest was low, signals in the cognitive control network were weaker. The most detrimental activation patterns were observed for the combination of low-competence and high interest. Our results reveal the combination of task and learner characteristics that best harnesses the potential benefits of negative feedback and illustrate the neuroscientific mechanisms underlying this observation. (shrink)

Diese Untersuchung wendet sich gegen die verbreitete Interpretationstendenz, Platons Anamnesislehre als Lehre von einer Art gelingender Identifikation auszulegen. Dabei wird behauptet, Platon habe geglaubt, der Mensch besitze auf eine mythisch unerklärliche Weise die Begriffe aller Dinge apriori in sich und brauche sich beim Anblick eines konkreten Einzeldings nur an diesen vorgeburtlichen Besitz zu erinnern, um dieses Ding begrifflich richtig zu identifizieren. Durch eine sorgfältige, dem Wortlaut im einzelnen folgende Interpretation zeigt Lee, daß der Mensch nach Platon lediglich in der Lage (...) ist, die allgemeinen Kriterien und Prinzipien des Denkens analytisch aufzudecken. Erst die methodische Erschließung und Anwendung dieser - apriorischen, d.h. in jeder Erfahrung vorausgesetzten - Kriterien ermöglicht ein Fortschreiten des Erkennens auch in Bezug auf Einzeldinge. Die Anamnesislehre erweist sich dadurch als eine immer noch bedenkenswerte kritische Reflexion auf die Bedingungen der Sicherheit des Erkennens. (shrink)

In this collection of writings drawn from Jonathan Edwards’s essays and topical notebooks, the great American theologian deals with key Christian doctrines including the Trinity, grace, and faith. The volume includes long-established pieces in the Edwards canon, newly reedited from the original manuscripts, as well as documents that have never before been published and that in some cases reveal new aspects of his theology.

For many centuries, philosophers and scientists have pondered the origins and nature of human intuitions about the properties of points, lines, and figures on the Euclidean plane, with most hypothesizing that a system of Euclidean concepts either is innate or is assembled by general learning processes. Recent research from cognitive and developmental psychology, cognitive anthropology, animal cognition, and cognitive neuroscience suggests a different view. Knowledge of geometry may be founded on at least two distinct, evolutionarily ancient, core cognitive systems for (...) representing the shapes of large-scale, navigable surface layouts and of small-scale, movable forms and objects. Each of these systems applies to some but not all perceptible arrays and captures some but not all of the three fundamental Euclidean relationships of distance (or length), angle, and direction (or sense). Like natural number (Carey, 2009), Euclidean geometry may be constructed through the productive combination of representations from these core systems, through the use of uniquely human symbolic systems. (shrink)

Although disoriented young children reorient themselves in relation to the shape of the surrounding surface layout, cognitive accounts of this ability vary. The present paper tests three theories of reorientation: a snapshot theory based on visual image-matching computations, an adaptive combination theory proposing that diverse environmental cues to orientation are weighted according to their experienced reliability, and a modular theory centering on encapsulated computations of the shape of the extended surface layout. Seven experiments test these theories by manipulating four properties (...) of objects placed within a cylindrical space: their size, motion, dimensionality, and distance from the space’s borders. Their findings support the modular theory and suggest that disoriented search behavior centers on two processes: a reorientation process based on the geometry of the 3D surface layout, and a beacon-guidance process based on the local features of objects and surface markings. Ó 2010 Elsevier Inc. All rights reserved. (shrink)

Disoriented animals from ants to humans reorient in accord with the shape of the surrounding surface layout: a behavioral pattern long taken as evidence for sensitivity to layout geometry. Recent computational models suggest, however, that the reorientation process may not depend on geometrical analyses but instead on the matching of brightness contours in 2D images of the environment. Here we test this suggestion by investigating young children's reorientation in enclosed environments. Children reoriented by extremely subtle geometric properties of the 3D (...) layout: bumps and ridges that protruded only slightly off the floor, producing edges with low contrast. Moreover, children failed to reorient by prominent brightness contours in continuous layouts with no distinctive 3D structure. The findings provide evidence that geometric layout representations support children's reorientation. (shrink)

This study investigates how collective corruption appears, using a computational method. Specifically, acknowledging that the characteristics of collective corruption process are analogous to percolation phenomena, we illuminate that collective corruption is formed by ongoing social interactions in an organizational boundary. By formulating a percolation-based system dynamics model, we consider the behavioral characteristics of collective corruption in terms of individuals’ corruption preferences governed by personal attributes on corruption. We also propose and examine scenarios regarding the formation of collective corruption.

In this study, we investigate, both theoretically and empirically, the impact of language gender marking on gender wage inequality and country income inequality. We find that nations with a higher level of gender marking in their dominant language have a higher wage gap between genders. Using an instrumental variable approach, we also find that gender marking has an indirect impact on country income inequality via gender wage inequality. Furthermore, we find evidence that the income inequality of a society as a (...) whole is affected by gender wage inequality. Finally, we document that linguistic gender marking outperforms survey-based cultural gender dimensions as a predictor of both gender wage inequality and country income inequality. (shrink)

Thesis (Ph. D.)--University of Hawaii at Manoa, 1995.

The generation of isometric force at the hand can be mediated by activating a few motor modules. Stroke induces alterations in motor modules underlying steady-state isometric force generation in the human upper extremity. However, how the altered motor modules impact task performance remains unclear as stroke survivors develop and converge to the three-dimensional target force. Thus, we tested whether stroke-specific motor modules would be activated from the onset of force generation and also examined how alterations in motor modules would induce (...) changes in force representation. During 3D isometric force development, electromyographic signals were recorded from eight major elbow and shoulder muscles in the paretic arm of 10 chronic hemispheric stroke survivors and both arms of six age-matched control participants. A non-negative matrix factorization algorithm identified motor modules in four different time windows: three “exploratory” force ramping phases and the stable force match phase. Motor module similarity and between-force coupling were examined by calculating the scalar product and Pearson correlation across the phases. To investigate the association between the end-point force representation and the activation of the motor modules, principal component analysis and multivariate multiple linear regression analyses were applied. In addition, the force components regressed on the activation profiles of motor modules were utilized to model the feasible force direction. Both stroke and control groups developed exploratory isometric forces with a non-linear relationship between EMG and force. During the force matching, only the stroke group showed abnormal between-force coupling in medial-lateral and backward-forward and medial-lateral and downward-upward directions. In each group, the same motor modules, including the abnormal deltoid module in stroke survivors, were expressed from the beginning of force development instead of emerging during the force exploration. The PCA and the multivariate multiple linear regression analyses showed that alterations in motor modules were associated with abnormal between-force coupling and limited feasible force direction after stroke. Overall, these results suggest that alterations in intermuscular coordination contribute to the abnormal end-point force control under isometric conditions in the UE after stroke. (shrink)