Objectives: To investigate the current situation of completing the informed consent for do-not-resuscitate (DNR) orders among the competent patients with terminal illness and the ethical dilemmas related to it. Participants: This study enrolled 152 competent patients with terminal cancer, who were involved in the initial consultations for hospice care. Analysis: Comparisons of means, analyses of variance, Student’s t test, χ2 test and multiple logistic regression models. Results: After the consultations, 117 (77.0%) of the 152 patients provided informed consent for hospice (...) care and DNR orders. These included 21 patients (17.9%) who signed the consent by themselves, and 96 (82.1%) whose consent sheet was signed only by family members. The reasons why patients were not involved in the discussions toward the consent (n = 82) included poor physical or psychological condition (44.9%), concerns of the consultant hospice team (37.2%), and the family’s refusal (28.2%). On a multivariate analysis, patients’ awareness of their poor prognosis (odds ratio = 4.07, 95% confidence interval = 2.05 to 8.07) and their understanding of hospice care (2.27, 1.33 to 3.89) were two independent factors (p<0.01) that influenced their participation in the discussions or their personal signature in the informed consent. Conclusion: The family-oriented culture in Asian countries may violate the principles of the Patient Self-Determination Act and the requirements of the Hospice Care Law in Taiwan, which inevitably poses an ethical dilemma. Earlier truth-telling and continuing education of the public by hospice care workers will be helpful in solving such ethical dilemmas. (shrink)

Over recent years, the issue of corruption in the public construction sector has attracted increasing attention from both practitioners and researchers worldwide. However, limited efforts are available for investigating the underlying factors of corruption in this sector. Thus, this study attempted to bridge this knowledge gap by exploring the underlying factors of corruption in the public construction sector of China. To achieve this goal, a total of 14 structured interviews were first carried out, and a questionnaire survey was then administered (...) to 188 professionals in China. Two iterations of multivariate analysis approaches, namely, stepwise multiple regression analysis and partial least squares structural equation modeling were successively utilized to analyze the collected data. In addition, a case study was also conducted to triangulate the findings obtained from the statistical analysis. The results generated from these three research methods achieve the same conclusion: the most influential underlying factor leading to corruption was immorality, followed by opacity, unfairness, procedural violation, and contractual violation. This study has contributed to the body of knowledge by exploring the properties of corruption in the public construction sector. The findings from this study are also valuable to the construction authorities as they can assist in developing more effective anti-corruption strategies. (shrink)

Over recent years, the issue of corruption in the public construction sector has attracted increasing attention from both practitioners and researchers worldwide. However, limited efforts are available for investigating the underlying factors of corruption in this sector. Thus, this study attempted to bridge this knowledge gap by exploring the underlying factors of corruption in the public construction sector of China. To achieve this goal, a total of 14 structured interviews were first carried out, and a questionnaire survey was then administered (...) to 188 professionals in China. Two iterations of multivariate analysis approaches, namely, stepwise multiple regression analysis and partial least squares structural equation modeling were successively utilized to analyze the collected data. In addition, a case study was also conducted to triangulate the findings obtained from the statistical analysis. The results generated from these three research methods achieve the same conclusion: the most influential underlying factor leading to corruption was immorality, followed by opacity, unfairness, procedural violation, and contractual violation. This study has contributed to the body of knowledge by exploring the properties of corruption in the public construction sector. The findings from this study are also valuable to the construction authorities as they can assist in developing more effective anti-corruption strategies. (shrink)

tập 1. Từ khởi nguyên đến thế kỷ XIV.

Efforts from diverse disciplines, including evolutionary studies and biomechanical experiments, have yielded new insights into the genetic, signaling, and mechanical control of tooth formation and functions. Evidence from fossils and non‐model organisms has revealed that a common set of genes underlie tooth‐forming potential of epithelia, and changes in signaling environments subsequently result in specialized dentitions, maintenance of dental stem cells, and other phenotypic adaptations. In addition to chemical signaling, tissue forces generated through epithelial contraction, differential growth, and skeletal constraints act (...) in parallel to shape the tooth throughout development. Here recent advances in understanding dental development from these studies are reviewed and important gaps that can be filled through continued application of evolutionary and biomechanical approaches are discussed. (shrink)

A coordinate-free formulation is established for (semi) classical particle-field interactions. The exterior language of spacetime chains and De-Rham currents enables the description to include extended strings and membranes besides point particles. Treating physical fields in terms of sections of particular bundles, a unified account of interactions is presented in terms of an intrinsic action principle on a bundle of jets over spacetime. The theory is illustrated by considering the specific model of point particles with intrinsic spin covariantly coupled to theU(1) (...) andSL(2, C) connections describing the electromagnetic and gravitational fields, respectively. The notion of dual spin is examined in this context and coupled equations for this particle-field system are explicitly derived in a local chart. Attention is drawn to the global implications of the theory. (shrink)

Starting from the importance of the figure of the parrhesiastes — the political and therapeutic truth- teller— for Foucault’s understanding of the care of the self, this paper traces the political figuration of the analogy between philosophers and physicians on the one hand, and rhetors and disease on the other in Plato’s Gorgias. I show how rhetoric, in the form of ventriloquism, infects the text itself, and then ask how we account for the effect of the “ contaminated ” philosophical (...) dialogue on our readerly health. Is the text placebo, vaccine, or virus? All of these options, I argue, complicate Foucault’s prescription for parrhesia, requiring us to think anew the continuing political ramifications of the metaphor of care. (shrink)

The authors present a case study involving truth telling responsibilities in the setting of nonepileptic seizures. Specifically, over the course of several suspected nonepileptic seizures, a patient’s seizures stopped after he received a saline flush meant to precede the administration of anti-seizure medication. The patient and his surrogate believed he had received the medication each time, and the team wondered whether they should disclose the truth. Some worried that disclosure would reinforce the suspected psychogenic behavior, exacerbating the patient’s condition. In (...) this way, the case study presents a twist on the traditional truth telling archetype. While most truth telling cases center on navigating cultural differences or worries about emotional harm, this case presented concerns about medical harm in the form of exacerbating the patient’s condition. The authors describe the complex patient-family-team dynamic that preceded this ethical dilemma, describe the case, analyze the ethical issue, and describe the outcome. (shrink)

We are told that when news of Caracalla's death reached Rome a group of senators denounced their former emperor, likening him to all the tyrants of the past who had ruled over them. The senator who recorded these actions, the historian Cassius Dio, does not say which tyrants were listed, but it is likely that such a comprehensive list included the last king of Rome, Tarquinius Superbus, and his son Sextus. The senators' actions were doubtless more an act of group (...) catharsis than a private show of loyalty to their new emperor, Marcus Opellius Macrinus. Yet what the scene reveals perhaps most clearly is the Romanexemplatradition in practice. (shrink)