End-of-life decision making frequently occurs in the intensive care unit (ICU). There is a lack of information on how a do-not-resuscitate (DNR) order affects treatments received by critically ill patients in ICUs. The objectives of this study were: (1) to compare the use of life support therapies between patients with a DNR order and those without; (2) to examine life support therapies prior to and after the issuance of a DNR order; and (3) to determine the clinical factors that influence (...) the initiation of a DNR order in ICUs in Taiwan. A prospective, descriptive, and correlational study was conducted. A total of 202 patients comprising 133 (65.8%) who had a DNR order, and 69 (34.1%) who did not, participated in this study. In the last 48 hours of their lives, patients who had a DNR order were less likely to receive life support therapies than those who did not have a DNR order. Older age, being unmarried, the presence of an adult child as a surrogate decision maker, a perceived inability to survive ultimate discharge from the ICU, and longer hospitalization in the ICU were significant predictors of issuing a DNR order for critically ill patients. This study will draw attention to how, when, and by whom, critically ill patients’ preferences about DNR are elicited and honored. (shrink)

This study empirically examined the effects of ethical leadership and ethical climate on employee ethical behavior in the international port context using survey data collected from 128 respondents who worked in Taiwan International Ports Corporation in Taiwan. Research hypotheses were formulated from the previous literature and tested using structural equation modeling. Results indicated that ethical leadership had a significant impact on ethical climate and the ethical behavior of TIPC employees. Ethical climate was found to be positively associated with employee ethical (...) behavior. The theoretical and practical implications of the research findings are discussed. (shrink)

Judging similarities among objects, events, and experiences is one of the most basic cognitive abilities, allowing us to make predictions and generalizations. The main assumption in similarity judgment is that people selectively attend to salient features of stimuli and judge their similarities on the basis of the common and distinct features of the stimuli. However, it is unclear how people select features from stimuli and how they weigh features. Here, we present a computational method that helps address these questions. Our (...) procedure combines image-processing techniques with a machine-learning algorithm and assesses feature weights that can account for both similarity and categorization judgment data. Our analysis suggests that a small number of local features are particularly important to explain our behavioral data. (shrink)

In this paper I test major analytic theories of interpretation, including anti-intentionalism, the value-maximizing theory, actual intentionalism, and hypothetical intentionalism, against Li Shang-yin’s poem ‘The Ornamented Zither’. I argue that, based on the results of the test, all of these theories face grave difficulties. If their supporters want their accounts to be sustained in the debate over interpretation, they need to address the worries I raise.

The utterance model is a popular basis for theories of interpretation in the contemporary analytic philosophy of literature. This model suggests that interpretation should be constrained by a work's identity‐relevant factors in its context of production because a work, like an utterance, acquires its identity and content in part from its relations with that context. From a descriptive point of view, I argue that the implied author account of interpretation best describes critical practice following the current positions based on the (...) utterance model. That is, people who interpret in accordance with these positions end up interpreting an implied author. (shrink)

Background Individual physicians and physician-associated factors may influence patients’/surrogates’ autonomous decision-making, thus influencing the practice of do-not-resuscitate orders. The objective of this study was to examine the influence of individual attending physicians on signing a DNR order. Methods This study was conducted in closed model, surgical intensive care units in a university-affiliated teaching hospital located in Northern Taiwan. The medical records of patients, admitted to the surgical intensive care units for the first time between June 1, 2011 and December 31, (...) 2013 were reviewed and data collected. We used Kaplan–Meier survival curves with log-rank test and multivariate Cox proportional hazards models to compare the time from surgical intensive care unit admission to do-not-resuscitate orders written for patients for each individual physician. The outcome variable was the time from surgical ICU admission to signing a DNR order. Results We found that each individual attending physician’s likelihood of signing do-not-resuscitate orders for their patients was significantly different from each other. Some attending physicians were more likely to write do-not-resuscitate orders for their patients, and other attending physicians were less likely to do so. Conclusion Our study reported that individual attending physicians had influence on patients’/surrogates’ do-not-resuscitate decision-making. Future studies may be focused on examining the reasons associated with the difference of each individual physician in the likelihood of signing a do-not-resuscitate order. (shrink)

In contemporary analytic philosophy of art, the intentionalist debate is about whether the author’s intention is relevant to the interpretation of her work. Various positions have been proposed, and in this paper I defend what I call hypothetical author-hypothetical intentionalism, the position that interpretation is based on the intention attributed to the author constructed from the work. There are three aims to achieve: (1) to give a general account of hypothetical author-hypothetical intentionalism; (2) to present a moderate version of hypothetical (...) author-hypothetical intentionalism; (3) to defend the moderate version of hypothetical author-hypothetical intentionalism against actual intentionalism and actual author-hypothetical intentionalism. Against the current trend that focuses on actual authors, I hope to show that the hypothetical author account is still a sustainable contender in the intentionalist debate. (shrink)

Physicians play a substantial role in facilitating communication regarding life-supporting treatment decision-making including do-not-resuscitate in the intensive care units. Physician-related fact...

Urban streetscapes are outdoor areas in which the general public can appreciate green landscapes and engage in outdoor activities along the street. This study tested the extent to which the degree of awareness of urban street trees impacts attention restoration and perceived restorativeness. We manipulated the degree of awareness of street trees. Participants were placed into four groups and shown different images: (a) streetscapes with absolutely no trees; (b) streetscapes with flashes of trees in which participants had minimal awareness of (...) the content; (c) streetscapes with trees; and (d) streetscapes with trees to which participants were told to pay attention. We compared the performance of 138 individuals on measures of attention and their evaluations of perceived restorativeness. Two main findings emerged. First, streetscapes with trees improved the performance of participants on attentional tests even without their awareness of the trees. Second, participants who had raised awareness of street trees performed best on the attentional test and rated the streetscapes as being more restorative. These findings enhance our knowledge about the role of an individual's awareness of restorative elements and have implications for designers and individuals who are at risk of attentional fatigue. (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)

Some theorists on literary interpretation have suggested a connection between Monroe C. Beardsley’s anti-intentionalism and hypothetical intentionalism based on an implied author. However, a full exploration has never been attempted. I undertake this task in this paper. A close reading of Beardsley reveals that he assumes something very similar to the implied author in interpretation. I distinguish five types of fictional works in terms of their narrative mode and show that my claim stands in at least four of the five (...) types. The significance of my argument lies in exposing the above version of authorism in anti-intentionalism. -/- Beardsley is generally perceived as advocating the irrelevance of authorial intention to literary interpretation. The common interpretation of his theory is that work-meaning is generated by linguistic conventions, with intention playing no role in meaning-determination. All the interpreter needs is knowledge of public, linguistic conventions in order to recover textual meaning. -/- Nevertheless, when dealing with the problem of interpretation, Beardsley explicitly talks about attributing textual meaning to a fictional speaker. Although he does not elaborate on the nature of this speaker, clues scattered in his writings point to the striking similarity of this theoretical apparatus to an implied author. The key lies in his presumption that every fictional work must have an ultimate speaker to whom meaning inferred from the text should be attributed. This claim is almost the core of an implied author theory of interpretation. -/- A difficulty in classifying Beardsley’s view as a version of the implied author position is that his characterization of the story’s presenter might apply better to the story’s narrator than to its implied author. To test this, I examine different types of narrative modes to see whether the fictional speaker merges with the implied author in each of these scenarios. -/- The first factor to consider for classifying narrative modes is whether the narrator’s presence is explicit or implicit. The narrative scenario in which the narrator is implicit can be further divided into two sub-types: either the story is told from an omniscient viewpoint or centers on the experience of a third-person character. In either case, the story is not told by any of the characters in the story; rather, it is told by an implicit speaker whose words the work purports to be. It seems reasonable to identify this fictional speaker with the implied author, for both function as the subject to which textual meaning is attributed. -/- As for the narrative mode in which the narrator is explicit, this involves first-person narratives. In these, either the narrator is reliable or unreliable. When the narrator is unreliable, a transcendental perspective is required in determining the text’s meaning, because what is said ultimately in the work is not equivalent to what is literally said by the unreliable narrator. It follows that an implicit speaker has to be assumed and she again coincides with the implied author. -/- Where the narrator is reliable but textual meaning transcends what is literally expressed, an implicit speaker is at play again. This narrative scenario is thus better classified as a case in which the narrator’s presence is implicit. This leaves us with the narrative scenario in which the narrator is a reliable spokesperson for the implied author. -/- The identification of the narrator with the implied author in the case last mentioned is controversial. The crucial difference between them is that the former is dramatized in the story while the latter is not. I accept that the narrator here is not happily called an implied author, though I also point out several similarities between the two. -/- Finally, I discuss four complications to my argument. The first concerns multiple points of view in a story. To accommodate this kind of narrative, Beardsley could argue that an implicit narrator is needed to explain the definite meaning concealed behind what is literally said by different characters. The second complication is about the ontological status accorded to the narrator and the implied author. It might be objected that the two reside in different fictional worlds and this is what makes their merging impossible. But it is questionable whether this is a definitional feature of the implied author; moreover, the interpreter can take the implied author to be an instrumentalist concept and hence avoid talk about the ontological status of fictional entities. The third complication claims that versions of the implied author position developed by philosophers tend to be based on a contextualist ontology of literature; however, Beardsley’s account is acontextual. This is not true, for Beardsley has exhibited contextualist leanings in his writings. Finally, it has been objected that the formalist resources Beardsley has are not enough to guarantee a single right interpretation. But if Beardsley is actually a contextualist, contextual constraints will come into play and raise the chance of getting a single right interpretation. -/- The article concludes by reflecting on the significance of the misrepresentation of anti-intentionalism: it is the intention of the actual author which anti-intentionalism is against. The position in question is actually developed in an intentionalist framework based on the implied author. (shrink)

Purpose Moral orientation can affect ethical decision-making. Very few studies have focused on whether medical education can change the moral orientation of the students. The purpose of the present study was to document the types of moral orientation exhibited by medical students, and to study if their moral orientation was changed after preclinical education. Methods From 2007 to 2009, the Mojac scale was used to measure the moral orientation of Taiwan medical students. The students included 271 first-year and 109 third-year (...) students. They were rated as a communitarian, dual, or libertarian group and followed for 2 years to monitor the changes in their Mojac scores. Results In both first and third-year students, the dual group after 2 years of preclinical medical education did not show any significant change. In the libertarian group, first and third-year students showed a statistically significant increase from a score of 99.4 and 101.3 to 103.0 and 105.7, respectively. In the communitarian group, first and third-year students showed a significant decline from 122.8 and 126.1 to 116.0 and 121.5, respectively. Conclusion During the preclinical medical education years, students with communitarian orientation and libertarian orientation had changed in their moral orientation to become closer to dual orientation. These findings provide valuable hints to medical educators regarding bioethics education and the selection criteria of medical students for admission. (shrink)

In this study, we examined the role of culture on early adolescents’ social reasoning about peer exclusion. A total of 80 U.S. and 149 Taiwanese early adolescents independently completed a social reasoning essay about peer exclusion. Analyses of the essays based on social-moral theories showed that U.S. students tended to reason about peer exclusion based on social conventional thinking whereas Taiwanese students were more attentive to personal and moral issues. Despite this difference, both groups of students referred to some common (...) social-moral concepts while reasoning about peer exclusion, including consideration of personal benefit, harming others’ welfare, personal concern, and punishment. The use of social reasoning strategies was similar across the two groups of students except that Taiwanese students relied more on judgment whereas U.S. students generated more alternative hypotheses. (shrink)

We explore the various ethical challenges that arise during the practical implementation of an emergency resource allocation protocol. We argue that to implement an allocation plan in a crisis, a hospital system must complete five tasks: (1) formulate a set of general principles for allocation, (2) apply those principles to the disease at hand to create a concrete protocol, (3) collect the data required to apply the protocol, (4) construct a system to implement triage decisions with those data, and (5) (...) create a system for managing the consequences of implementing the protocol, including the effects on those who must carry out the plan, the medical staff, and the general public. Here we illustrate the complexities of each task and provide tentative solutions, by describing the experiences of the Coronavirus Ethics Response Group, an interdisciplinary team formed to address the ethical issues in pandemic resource planning at the University of Rochester Medical Center. While the plan was never put into operation, the process of preparing for emergency implementation exposed ethical issues that require attention. (shrink)

This paper attempts to revive interest in the speech act theory of literature by looking into Monroe C. Beardsley's account in particular. Beardsley's view in this respect has received, surprisingly, less attention than deserved. I first offer a reconstruction of Beardsley's account and then use it to correct some notable misconceptions. Next, I show that the reformulation reveals a hitherto unnoticed discrepancy in Beardsley's position and that this can be explained away by a weak version of intentionalism that Beardsley himself (...) actually tolerates. Finally, I assess the real difficulty of Beardsley's theory and its relevance today. (shrink)

Interpretation in art refers to the attribution of meaning to a work. A point on which people often disagree is whether the artist’s or author’s intention is relevant to the interpretation of the work. In the Anglo-American analytic philosophy of art, views about interpretation branch into two major camps: intentionalism and anti-intentionalism, with an initial focus on one art, namely literature. -/- This article elaborates on variations on these theories of interpretation and considers their notable objections. The debate about interpretation (...) covers other art forms in addition to literature. The theories of interpretation are also extended across many of the arts. This broad outlook is assumed throughout the article, although nothing said is affected even if a narrow focus on literature is adopted. (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)

Business moral values are defined as the personal moral values held by individuals who are engaged in business interactions. Direct supervisors may play an important role in shaping the business moral values of their subordinates. Using 264 supervisor— subordinate dyadic data from Taiwanese organizations, the study investigated the relationships among supervisor business moral values, subordinate business moral values, subordinate organizational commitment, job performance, and attendance. The results indicated that supervisor business moral values were positively associated with subordinate business moral values, (...) and that the latter mediated the relationship between the former and subordinate outcomes. Implications for business moral values research are discussed. (shrink)

This study aims to disclose how the magnetic resonance imaging neuroimaging approach has been applied in education studies, and what kind of learning themes has been investigated in the reviewed MRI neuroimaging research. Based on the keywords “brain or neuroimaging or neuroscience” and “MRI or diffusion tensor imaging or white matter or gray matter or resting-state,” a total of 25 papers were selected from the subject areas “Educational Psychology” and “Education and Educational Research” from the Web of Science and Scopus (...) from 2000 to 2019. Content analysis showed that MRI neuroimaging and learning were studied under the following three major topics and nine subtopics: cognitive function, science education, and brain development. As for the type of MRI neuroimaging research, the most frequently used approaches were functional MRI, followed by structural MRI and DTI, although the choice of approach was often motivated by the specific research question. Research development trends show that the neural plasticity theme has become more prominent recently. This study concludes that in educational research, the MRI neuroimaging approach provides objective and empirical evidence to connect learning processes, outcomes, and brain mechanisms. (shrink)

As the negative environmental impacts of transportation systems become more severe, governments and environmental groups are seeking more sustainable transportation options, such as replacing fuel-powered vehicles with electric vehicles and expanding public transportation systems to reduce the number of people driving on their own, in order to reduce the environmental impacts of transportation systems. At present, the rapid expansion of public transportation systems is not an easy task and requires a long period of time to plan for expansion and construction, (...) so people are increasingly looking to find means of transportation that meet sustainable conditions as solutions. In this context, electric bicycles are one of the solutions that people can choose, with benefits such as energy saving, carbon reduction, effective air pollution reduction, and simple and labor-saving riding. However, in Taiwan, despite the many benefits of electric bicycles, their popularity is not high. Therefore, this study focuses on the factors that affect the purchase of electric bicycles in Taiwan. The Influential Network Relation Map generated by the Z-based Decision-making Trial and Evaluation Laboratory technique is used to describe the influence relationships among the factors and to establish the key evaluation criteria of electric bicycle purchase intention. The results indicate that vehicle price, safety, motor performance, battery life, and battery durability are the most important factors in purchasing electric bicycles. Furthermore, the power of motor is considered as the factor that most significantly affects other criteria, while safety and price are most likely to be affected by other criteria. This study has contributed to academia and industry, for the dependency weights of these factors are set to provide a scientific and systematic way to show how consumers think in the decision-making process and to provide more reliable information and management implications for the electric bicycle industry. (shrink)

Modest actual intentionalism is a major position on interpretation in contemporary analytic aesthetics. The position consists of a disjunctive formulation according to which work-meaning is determined by the author’s intention when such intention succeeds or by non-intentionalistic factors when it fails. I challenge the disjunctive view by presenting a constructive dilemma, the conclusion being that modest actual intentionalism ends up either making non-intentionalistic factors idle or making authorial intent superfluous.

This study explored the effect of learning strategies in a student organization on cake art creativity. The participants were 27 student members of a cake decorating art club from one central university in Taiwan. A quasi-experimental pretest-posttest design was adopted, with 90 h of experimental teaching over 16 weeks. The results, which included the use of a questionnaire, classroom observation, and in-depth interviews, suggest that in terms of creativity, the group participating in flipped classroom learning significantly outperformed the group using (...) traditional learning strategies. Furthermore, flipped classroom learning promoted learner motivation and satisfaction. (shrink)

Monroe C. Beardsley has been interpreted by many theorists as advocating antiexternalism with respect to an artwork's aesthetically relevant properties, typically its meaning. According to this orthodox interpretation, the meaning of a work is not established by external or contextual factors but by what is internally present in the work. This acontextual account of meaning is challenged by contextualism, which claims that a work's identity and meaning are in part determined by contextual factors. However, a close look at textual evidence (...) shows that Beardsley actually leans toward contextualism. In particular, his speech act theory of literature compels him to hold an explicit contextualist position with respect... (shrink)

Obtaining adequate informed consent from trauma patients is challenging and time-consuming. Healthcare providers must communicate complicated medical information to enable patients to make informed decisions. This study aimed to explore the challenges of obtaining valid consent and methods of improving the quality of the informed consent process for surgical procedures in trauma patients. We conducted a systematic review of relevant English-language full-text original articles retrieved from PubMed that had experimental or observational study design and involved adult trauma patients. Studies involving (...) informed consent in clinical or research trials were excluded. Titles and abstracts of searched articles were reviewed and relevant data were extracted with a structured form. Results were synthesized with a narrative approach. A total of 2044 articles were identified in the initial search. Only eight studies were included in the review for narrative synthesis. Six studies involved orthopedic surgeries, one involved nasal bone surgeries, and one involved trauma-related limb debridement. Only one study was conducted in an emergency department. Information recall was poor for trauma patients. Risk recall and comprehension were greater when written or video information was provided than when information was provided only verbally. Patient satisfaction was also greater when both written and verbal information were provided than when verbal information alone was provided; patients who received video information were more satisfied than patients who received written or verbal information. Many articles have been published on the subject of informed consent, but very few of these have focused on trauma patients. More empirical evidence is needed to support the success of informed consent for trauma patients in the emergency department, especially within the necessarily very limited time frame. To improve the informed consent process for trauma patients, developing a structured and standardized informed consent process may be necessary and achievable; its effectiveness would require evaluation. Adequately educating and training healthcare providers to deliver structured, comprehensive information to trauma patients is crucial. Institutions should give top priority to ensuring patient-centered health care and improved quality of care for trauma patients. (shrink)

Monroe C. Beardsley's unavailability argument is one of the most underrated anti‐intentionalist arguments in the philosophy of interpretation. The main idea of this argument is that, since independent evidence of authorial intent is normally unavailable, the literary interpreter should focus on what a text means rather than on what the author intends it to mean. In this article I propose a revised version of the argument to show that the unavailability of authorial intent suffices to make actual intentionalism untenable as (...) a recommendation for finding out textual meaning. (shrink)

BackgroundThe therapeutic effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD) is related to the modulation of pathological neural activities, particularly the synchronization in the β band (13–35 Hz). However, whether the local β activity in the STN region can directly predict the stimulation outcome remains unclear.ObjectiveWe tested the hypothesis that low-β (13–20 Hz) and/or high-β (20–35 Hz) band activities recorded from the STN region can predict DBS efficacy.MethodsLocal field potentials (LFPs) were recorded in (...) 26 patients undergoing deep brain stimulation surgery in the subthalamic nucleus area. Recordings were made after the implantation of the DBS electrode prior to its connection to a stimulator. The maximum normalized powers in the theta (4–7 Hz), alpha (7–13 Hz), low-β (13–20 Hz), high-β (20–35 Hz), and low-γ (40–55 Hz) subbands in the postoperatively recorded LFP were correlated with the stimulation-induced improvement in contralateral tremor or bradykinesia–rigidity. The distance between the contact selected for stimulation and the contact with the maximum subband power was correlated with the stimulation efficacy. Following the identification of the potential predictors by the significant correlations, a multiple regression analysis was performed to evaluate their effect on the outcome.ResultsThe maximum high-β power was positively correlated with bradykinesia–rigidity improvement (rs = 0.549, p < 0.0001). The distance to the contact with maximum high-β power was negatively correlated with bradykinesia–rigidity improvement (rs = −0.452, p < 0.001). No significant correlation was observed with low-β power. The maximum high-β power and the distance to the contact with maximum high-β power were both significant predictors for bradykinesia–rigidity improvement in the multiple regression analysis, explaining 37.4% of the variance altogether. Tremor improvement was not significantly correlated with any frequency.ConclusionHigh-β oscillations, but not low-β oscillations, recorded from the STN region with the DBS lead can inform stimulation-induced improvement in contralateral bradykinesia–rigidity in patients with PD. High-β oscillations can help refine electrode targeting and inform contact selection for DBS therapy. (shrink)

Growing demand for direct care workers to assist care-dependent elderly people has created an opening for migrant workers from low- income nations to sell their services to middle and high-income nations. Using Singapore as a case example, we draw on capability theory to make the case that receiving nations that import direct care workers should be held to global justice standards that protect workers’ floor level human capabilities. Specifically, we (1) show that Singapore and other receiving nations fail to protect (...) human capabilities at a threshold level required by dignity; (2) identify specific human capabilities placed at risk; and (3) recommend standards for receiving nations that support central capabilities. As populations in both developed and developing nations are rapidly aging, these concerns could not be timelier. (shrink)

Digitalization and advanced technologies are replacing human jobs. Around the world, many people have lost their jobs due to increasing digitalization. Similarly, Chinese expatriates associated with the manufacturing sector in emerging countries such as Vietnam face similar challenges. Therefore, Chinese expatriates need to bring competitiveness in their competencies. This competitiveness brings sustainability to their career. The aim of this study is to investigate the impact of career competencies on career sustainability. Moreover, we test the mediating effect of lifelong learning in (...) the relationship between career competencies and career sustainability. A questionnaire survey approach was used in this study. The target population was the Chinese expatriate managers working at China-invested manufacturing multinational organizations in Vietnam. To estimate the proposed relationships, we use structural equation modeling. The results are confirmed that in the direct relationship career competence has a positive impact on career sustainability. The findings of this study also indicate that career competencies have a positive impact on lifelong learning. Furthermore, outcomes confirmed that lifelong learning has a positive impact on career sustainability. Similarly, results are also confirmed that lifelong learning is positively mediating between career competencies and career sustainability. Therefore, the empirical results of this article identify that lifelong learning has a critical impact on sustainable careers. Specifically, this study is useful for mid-level managers who are associated with multinational organizations. At the end of this article, we also explained the practical implications, limitations, and future research directions. (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)