While univariate functional magnetic resonance imaging data analysis methods have been utilized successfully to map brain areas associated with cognitive and emotional functions during viewing of naturalistic stimuli such as movies, multivariate methods might provide the means to study how brain structures act in concert as networks during free viewing of movie clips. Here, to achieve this, we generalized the partial least squares analysis, based on correlations between voxels, experimental conditions, and behavioral measures, to identify large-scale neuronal networks activated during (...) the first time and repeated watching of three ∼5-min comedy clips. We identified networks that were similarly activated across subjects during free viewing of the movies, including the ones associated with self-rated experienced humorousness that were composed of the frontal, parietal, and temporal areas acting in concert. In conclusion, the PLS method seems to be well suited for the joint analysis of multi-subject neuroimaging and behavioral data to quantify a functionally relevant brain network activity without the need for explicit temporal models. (shrink)

A deterrence theory of punishment holds that the institution of criminal punishment is morally justified because it serves to deter crime. Because the fear of external sanction is an important incentive in crime deterrence, the deterrence theory is often associated with the idea of severe, disproportionate punishment. An objection to this theory holds that hope of escape renders even the severest punishment inapt and irrelevant. -/- This article revisits the concept of deterrence and defend a more plausible deterrence theory of (...) punishment—the wide-scope deterrence theory. The wide-scope theory holds that we must make the best use of all the deterrence tools available, including both external and internal sanctions. Drawing on insights from the early Confucian tradition, the article develops a deep deterrence theory, which holds that the most important deterrence tool involves internal, not external, sanction. It describes how internal sanctions deter potential offenses and why relevant policies need not conflict with liberalism’s respect for neutrality. (shrink)

The purposes of research were to describe the neonatal clinicians' personal views and attitudes on neonatal ethical decision-making, to identify factors that might affect these attitudes and to compare the attitudes between neonatal physicians and neonatal nurses in Taiwan. Research was a cross-sectional design and a questionnaire was used to reach different research purposes. A convenient sample was used to recruit 24 physicians and 80 neonatal nurses from four neonatal intensive care units in Taiwan. Most participants agreed with suggesting a (...) do not resuscitate (DNR) order to parents for dying neonates (86.5%). However, the majority agreed with talking to patients about DNR orders is difficult (76.9%). Most participants agree that review by the clinical ethics committee is needed before the recommendation of ‘DNR’ to parents (94.23%) and nurses were significantly more likely than physicians to agree to this (p=0.043). During the end-of-life care, most clinicians accepted to continue current treatment without adding others (70%) and withholding of emergency treatments (75%); however, active euthanasia, the administration of drug to end-of-life, was not considered acceptable by both physicians and nurses in this research (96%). Based on our research results, providing continuing educational training and a formal consulting service in moral courage for neonatal clinicians are needed. In Taiwan, neonatal physicians and nurses hold similar values and attitudes towards end-of-life decisions for neonates. In order to improve the clinicians' communication skills with parents about DNR options and to change clinicians' attitudes for providing enough pain-relief medicine to dying neonates, providing continuing educational training and a formal consulting service in moral courage are needed. (shrink)

Background Adherence to ethical guidelines and regulations and protecting and respecting the dignity and autonomy of participants by obtaining a valid informed consent form (ICF) prior to participation in research are crucial; The subjects did not add signatures next to the corrections made to signatures or dates on the ICF, Multiple signatures in other fields, ICF missing/missing signature, Incorrect ICF version Signed after modification, Correction tape used to correct signature, Impersonated signature, Non-research-member signature, however, ICFs are often not properly completed, (...) which must be addressed. This study analyzed ICF signing errors and implemented measures to reduce or prevent these errors. Methods We used the plan–do–check–act (PDCA) cycle to help improve the correctness and validity of ICF signing. Results Interim and final reports from January 2016 to February 2020 including 363 ICFs were studied. The total proportion of correct ICF signatures (200, 83.3%) following the PDCA intervention was significantly higher than that before the intervention (P < 0.05). Analysis of the types of signing error demonstrated that signature errors were significantly reduced after the intervention, particularly for subjects did not add signatures next to the corrections made to signatures or dates on the ICF (16, 6.7%) and impersonated signature (0; P < 0.05). Conclusions The proportions of other error types—multiple signatures in other fields, missing or unsigned ICF, incorrect signature order, incorrect ICF version, use of correction tape to correct signature, and non-medical profession members signing the ICF—did not differ significantly. (shrink)

David Miller argues that national identity is indispensable for the successful functioning of a liberal democracy. National identity makes important contributions to liberal democratic institutions, including creating incentives for the fulfilment of civic duties, facilitating deliberative democracy, and consolidating representative democracy. Thus, a shared identity is indispensable for liberal democracy and grounds a good claim for self-determination. Because Miller’s arguments appeal to the instrumental values of a national culture, I call his argument ‘instrumental value’ arguments. In this paper, I examine (...) the instrumental value arguments and show that they fail to justify a group’s right to self-determination. (shrink)

Moral thinking and communication are critical competencies for confronting social dilemmas in a challenging world. We examined these moral competencies in 70 college students and graduates from Taiwan, the United Kingdom, and the United States. Participants were assessed through semi-structured written interviews, Facebook group discussions, and a questionnaire. In this paper, we describe the similarities and differences across cultural groupings in (1) the social issues of greatest importance to the participants; (2) the factors influencing their approaches to thinking about social (...) issues and communicating with others; and (3) the characteristics of their moral functioning in terms of moral awareness, moral judgment, moral discourse, and moral decision-making. (shrink)

To contribute to the debate on the role of social media in responsible business, this article explores blogger buzz in reaction to food companies’ press releases on health and obesity issues, considering the content and the level of fit between the CSR initiatives and the company. Findings show that companies issued more product-related initiatives than promotion-related ones. Among these, less than half generated a substantial number of responses from bloggers, which could not be identified as a specific group. While new (...) product introductions led to positive buzz, modifications of current products resulted in more negative responses, even if there was a high fit with core business. While promotion-related press releases were received negatively in general, particularly periphery promotion generated most reactions. Our exploratory study suggests that companies can increase the likelihood of a positive reaction if they carefully consider the fit between initiatives and their core business, while taking the notion of ‘controversial fit’, relating to the unhealthy nature of original products, into account. Further research avenues and implications, as well as limitations, are discussed. (shrink)

In this paper, I propose a new self-defense theory of punishment, the rights-protection theory. By appealing to the interest theory of right, I show that what we call “the right of self-defense” is actually composed of the right to protect our basic rights. The right of self-defense is not a single, self-standing right but a group of derivative rights justified by their contribution to the protection of the core, basic rights. Thus, these rights of self-defense are both justified and constrained (...) by the basic rights they are supposed to protect. I then explain how this theory responds to a common objection. Opponents argue that, to exercise the right of self-defense, some threat must be present. However, in the context of punishment, the threat has already taken effect or is already gone. Thus, the right of self-defense becomes irrelevant when we punish an offender. I show that this objection is based on an implausibly narrow conception of self-defense. A reasonable conception would allow us to exercise our right of self-defense when there is a present definite threat, a future definite threat, or a potential threat. Thus, we may still exercise our right of self-defense in the context of punishment. (shrink)

In this chapter, I consider contemporary consequentialist theories of punishment. Consequentialist theories of punishment look to the consequences of punishment to justify the institution of punishment. Two types of theories fall into this category—teleology and aggregationism. I argue that teleology is implausible as it is based on a problematic assumption about the fundamental value of criminal punishment, and that aggregationism provides a more reasonable alternative. Aggregationism holds that punishment is morally justified because it is an institution that helps society to (...) aggregate important moral values. Several theories fall into this category, including general deterrence theories, specific deterrence theories, and preventionism. I critically evaluate these theories and argue that only one specific deterrence theory, namely, my rights-protection theory, provides the most reasonable consequentialist account of punishment. (shrink)

A number of philosophers argue that the moral value of national identity is sufficient to justify at least a prima facie right of a national community to create its own independent, sovereign state. In the literature, this argument is commonly referred to as the identity argument. In this paper, I consider whether the identity argument successfully proves that a national group is entitled to a state of its own. To do so, I first explain three important steps in the argument (...) and then consider whether they lead to the desired conclusion. My examination reveals that the identity argument relies on the Optimal Protection Principle; however, this principle does not apply to the case of a national community. As a result, the identity argument fails to justify even a prima facie right of a national community to establish its own state. (shrink)

Allen Buchanan proposes a methodological framework with which theorists may evaluate different theories of secession, including the National Self-Determination theory. An important claim he makes is, because the right to secede is inherently institutional, any adequate theory of secession must include, as an integral part, an analysis of institutional morality. Because the National Self-Determination theory blatantly lacks such an analysis, Buchanan concludes that this theory is inherently flawed. In this paper, I consider Buchanan’s framework and the responses from supporters of (...) national self-determination theory. I try to clarify the confusion shared by both parties. I conclude that, although Buchanan’s theory of institutional morality is sound, his critiques of the national self-determination theory fails. (shrink)

Despite the increasing number of studies on user experience and user interfaces, few studies have examined emotional interaction between humans and deformable objects. In the current study, we investigated how the anthropomorphic design of a flexible display interacts with emotion. For 101 unique 3D images in which an object was bent at different axes, 281 participants were asked to report how strongly the object evoked five elemental emotions (e.g., happiness, disgust, anger, fear, and sadness) in an online survey. People rated (...) the object’s shape using three emotional categories: happiness, disgust–anger, and sadness–fear. It was also found that a combination of axis of bending (horizontal or diagonal axis) and convexity (bending convexly or concavely) predicted emotional valence, underpinning the anthropomorphic design of flexible displays. Our findings provide empirical evidence that axis of bending and convexity can be an important antecedent of emotional interaction with flexible objects, triggering at least three types of emotion in users. (shrink)

Green consumers are those who seek to fulfill economic responsibility with their choices of environment-friendly products. Previous research found that it is not easy to identify green consumers by using traditional demographic or psychographic measurements due to the instability of moral attitude and actual behavior. The frontal theta brain waves of 19 right-handed respondents were recorded and analyzed in a choice task between an environment-friendly (green) product and a conventional product. Product information, which was provided to the respondents, included written (...) descriptions as well as the price of each product without visual depiction. Based on the respondents’ choice, they were classified into two groups: green (GR) consumers who chose an environment-friendly product option and non-green (Non-GR) consumers who chose the option of a conventional product. While processing the green product message, we discovered that frontal theta activations were significantly higher among GR consumers than Non-GR consumers. On the contrary, the frontal theta waves of GR consumers were not differentiated from Non-GR consumers while processing the price information. Therefore, theta activations in the frontal area may potentially be a unique neural indicator of GR consumers’ cognitive engagement with environment-friendly product messages. (shrink)

Both Kymlicka and Patten argue that the equal treatment of different national groups require that the state officially recognize the right of each to create its own autonomous government. After carefully examining their arguments, I show that they both make the false assumption that, in a multinational state, the state belongs only to the majority group but not the minority, and that a multination state can never treat minority groups equally. Both claims are inherently anti-pluralistic. Thus, the equal treatment of (...) different national cultures does not require that each be granted the right to self-government. (shrink)

The principle of national self-determination holds that a national community, simply by virtue of being a national community, has a prima facie right to create its own sovereign state. While many support this principle, not as many agree that it should be formally recognized by political institutions. One of the main concerns is that implementing this principle may lead to certain types of inequalities—between nations with and without their own states, members inside and outside the border, and members and nonmembers (...) inside the same nation state. While these inequalities may arise, I shall argue that they are not unjust. These worries are partly the results of confusing two types of interests that a national group may have—in cultural affairs and in political affairs. While a national community should enjoy rights over their cultural affairs, this does not grant them authority over other non-cultural, political affairs. Once the distinction is drawn, we can see that there are constraints on the implementation of this principle. Consequently, these inequalities justify setting limits to a group’s right of self-government, although they do not conclusively refute the right itself. (shrink)

In this chapter, Lee considers contemporary consequentialist theories of punishment. Consequentialist theories look to the consequences of punishment to justify the institution of punishment. Two types of theories fall into this category—teleology and aggregationism. Lee argues that teleology is implausible because it is based on a problematic assumption about the fundamental value of criminal punishment. Aggregationism is a more reasonable alternative. It holds that punishment is morally justified because it is an institution that helps society to aggregate important moral values. (...) Several theories fall into this category, including general deterrence theories, specific deterrence theories, and preventionism. Lee critically evaluates these theories and argues that only one specific deterrence theory, namely, her rights-protection theory, provides the most reasonable consequentialist account of punishment. (shrink)

National identity and attachment to national culture have taken root even in this era of globalization. National sentiments find expression in multiple political spheres and cause troubles of various kinds in many societies, both domestically and across state borders. Some of these problems are rooted in history; others are the result of massive global immigration. As US Secretary of State John Kerry tries to broker a new round of Israel-Palestine peace talks, the Israeli government continues expanding its settlements in disputed (...) territories. As this proposal is being written, Japanese citizens are debating whether their politicians should visit the Yasukuni Shrine (靖國神社), where the spirits of fourteen Class A war criminals from WWII and more than one thousand others convicted of war crimes by the International Military Tribunal for the Far East are honored with a distinguished resting place. As the Chinese government’s plan to bring economic prosperity to the Xinjian province unfolds, ethnic conflicts between Han Chinese and local Uyghur Muslims intensify. Tibetans still demonstrate to the Chinese government, some through the dramatic sacrifice of self-immolation, their determination to pursue a Tibet that is truly free and autonomous. The recent inflow of Muslim immigrants across Europa and North America forces those liberal democratic societies to rethink the meaning of multiculturalism. Should the state respect Muslim women’s freedom to wear burkas in public? What about other aspects of certain Muslim traditions such as arranged marriages or the honor killing of teenage girls who see boys their parents do not approve? Since these immigrants voluntarily moved from their homeland to a new society, do they have a duty to give up such practices, which conflict with their new societies’ fundamental commitment to individual autonomy? Eric Hobsbawm suggests that nationalism is a contingent phenomenon in history—it arises with important historical events such as industrialization and print journalism; eventually, it will disappear. Anthony Smith, on the other hand, argues that nationalism is deeply rooted in the human need for collective faith and dignity. How should we understand today’s nationalism? Is it a transient phenomenon that eventually will be eradicated from the world, or is it a timeless issue that confronts and will remain a challenge for every society? Is the conventional distinction between civic and cultural nationalism still relevant or helpful? The problems and ongoing challenges of nationalism are very much alive throughout East Asia where the myth of ethnically and culturally homogeneous nations is still paramount. In addition to the examples provided above, East Asian societies are increasingly multicultural, inevitably forcing their governments to come up with new immigration and border-control policies, revisit their laws regarding labor policies, sociopolitical discrimination, socioeconomic welfare, and, more fundamentally, rethink the constitutional make-up of the citizenry and the ideal of social harmony, one of their most cherished political values. Nevertheless, contemporary theoretical analyses, whether philosophical or empirical, of the phenomena surrounding nationalism, in all its forms, are almost exclusively focused on cases in western cultures and societies, preventing the East Asian people from developing a coherent idea of who they are or should be in a way that can track their deeply-held values and norms (such as Confucianism). One of the primary aims of this conference therefore is to address this ongoing neglect and explore new concepts and theories that are socially relevant in East Asia. Not only will this provide access to the particular experiences of nation, citizenship, and nationalism throughout East Asia but it will bring to bear philosophical concepts, approaches, and styles of reasoning about them that currently are not part of this critical debate. Providing an opportunity to hear these distinct and different East Asian voices and opening up these conceptual and methodological resources to scholars around the world will greatly advance the understanding and appreciation of nationalism. In addition to this primary aim, the proposed conference will achieve two other, novel, and important goals. First, by design, it will bring to bear a multi and interdisciplinary approach to the problems of nationalism. We are not privileging either conceptual or empirical studies in the organization of our conference and will bring together philosophers, political scientists, sociologists, and historians, making every effort to invite scholars who explicitly employ or are interested in exploring different and at times hybrid approaches. Second, we will draw together scholars from around the world: China, South Korea, Japan, Taiwan, North America, and Europe, including leading figures in the field, who will serve as keynote speakers for the conference. Combining these two additional goals will enable us to organize a uniquely diverse conference, both in terms of intellectual discipline and national origin. Along with our primary aim of introducing East Asian voices and theories, this will make our event original, distinctive, and unprecedented in value. Our age is one in which it is unavoidable for people of different cultural backgrounds to live together in many different places. For the sake of justice and stability, a comprehensive re-examination of nationalism is both urgent and necessary. (shrink)

Although national identity is valuable in a variety of ways, I argue that its value is not sufficient to justify a group’s right to govern itself, either in the form of an independent, sovereign state or an autonomous, sub-state government. My thesis is somewhat unusual—most philosophers who affirm the value of national identity also endorse the right of a national community to some form of self-government, and most philosophers who deny that a national community has the right to any form (...) of self-government also deny the value of national identity. (shrink)

In April 2011, the Korea Centers for Disease Control and Prevention announced the results of an epidemiological investigation that an unknown cause of lung disease that occurred throughout Korea was caused by humidifier disinfectants. The unprecedented social catastrophe caused by humidifier disinfectants, a household chemical, has so far reported 1,784 deaths and 5,984 survivors in South Korea. This study was designed to investigate the multi-layer relationships between psychological symptoms and adaptive functioning in survivors of the Humidifier disinfectants in South Korea (...) caused by chemical toxic substances. Specifically, this study aimed to explore how psychological symptoms affect actual interpersonal relationships and job adjustment with two variable sets, six internalizing and externalizing subscales, and three adaptation subscales. A total of 224 survivors recruited from a program to support humidifier disinfectant survivors by the government participated in this study. This research was approved by the Institutional Review Board of one of the Universities in South Korea. The age range of the participants was 18–73 years, 37.1% were male, and 62.9% were female. The participants responded to the Adult Self-Report of the Achenbach System of Empirically Based Assessment. A Canonical Correlation Analysis generated three unique patterns in the relationships between psychological symptoms and adaptive functions. Humidifier disinfectant survivors in the first pattern were more vulnerable to psychological symptoms and showed maladaptive functioning in life. Survivors in the second pattern showed intrusive behaviors and appeared to be adaptive in relationships with friends. Finally, survivors in the third pattern showed aggressive behaviors and reported poor partner relationships while showing good relationships with friends. The practical implications of the interventions are also discussed. (shrink)

The current moral education is focused on character building of Lickona. Several papers and books pointed out that his thesis has some drawbacks. As a teacher in charge of moral education in class, I have also found out them without effort. For these reasons, I simply pointed out disadvantages of Lickona’s thesis on this paper, then studied how to apply philosophical community of inquiry (PCOI) as the new model of moral education for Korean middle school classes (Now I teach students (...) moral subject at Wondong middle school in Gyeong-nam, Republic of Korea). This study is thought to be well-grounded as an alternative idea because it has been very successful when I have tried to apply PCOI model to Korean classroom for about 4 years. With this PCOI model, I won the first rank in Gyeong-nam secondary teaching contest in 2007. I have tried to apply PCOI model to Korean history, economy, the world history and geography class as well as moral class. And I have been studying how to apply to these subjects more effectively. (shrink)

Piracy is the greatest threat facing the music industry worldwide today. This study developed and empirically tested a model examining the antecedents of consumer attitude and behavioral intention toward music piracy behavior. Two types of music piracy behavior, unauthorized duplication/download and pirated music product purchasing, were examined. Based on a field survey in Taiwan, the results showed that attributive satisfaction, perceived prosecution risk, magnitude of consequence, and social consensus are very important in influencing customers attitude and behavioral intention toward two (...) types of music piracy behavior. In addition, singer/band idolization can affect the attitude and behavioral intention in the case of pirated music product purchasing. Perceived proximity was found to affect the attitude and behavioral intention in the case of pirated music product purchasing. However, it only influenced behavioral intention in the case of unauthorized duplication/download. (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)

Attending cram school has long been a trend in ethnic Chinese culture areas, including Taiwan. Despite the fact that school reform policies have been implemented in Taiwan, cram schools have continued to prosper. Therefore, in this educational culture, how to achieve a good educational effect is also a topic worthy of discussion. However, whether students really engage in those tutoring programs provided by cram schools has seldom been studied. To address this gap, this study explored how parents’ hovering attitude toward (...) life and coursework influences their children’s engagement in cram schools. This study targeted those students who attend English cram schools to test the correlates between two types of helicopter parenting, tutoring engagement and continued attendance at cram schools. A total of 320 questionnaires were sent out, and 300 were returned, giving an overall response rate of 93.75%. Excluding seven incomplete or invalid questionnaires, 293 valid questionnaires were received. The results of this study show that hovering behavior awareness is negatively related to cram school engagement, whereas cram school engagement is positively related to the intention to continue attending cram school. Moreover, the results imply that parents should alleviate their helicoptering behavior to enhance their children’s engagement in cram school tutoring programs. (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)

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)

BackgroundThis study aimed to identify the healthcare providers’ experience and perspectives toward end-of-life care decisions focusing on end-of-life discussion and physician’s order of life-sustaining treatment documentation in Korea which are major parts of the Life-Sustaining Treatment Act.MethodsA cross-sectional survey was conducted using a questionnaire developed by the authors. A total of 474 subjects—94 attending physicians, 87 resident physicians, and 293 nurses—participated in the survey, and the data analysis was performed in terms of frequency, percentage, mean and standard deviation using the (...) SPSS 24.0 program.ResultsStudy results showed that respondents were aware of terminal illness and physician’s order of life-sustaining treatment in Korea well enough except for some details. Physicians reported uncertainty in terminal state diagnosis and disease trajectory as the most challenging. Study participants regarded factors (related to relationships and communications) on the healthcare providers’ side as the major impediment to end-of-life discussion. Study respondents suggested that simplification of the process and more staff are required to facilitate end-of-life discussion and documentation.ConclusionBased on the study results, adequate education and training for better end-of-life discussion are required for future practice. Also, a simple and clear procedure for completing a physician’s order of life-sustaining treatment in Korea should be prepared and legal and ethical advice would be required. Since the enactment of the Life-Sustaining Treatment Act, several revisions already have been made including disease categories, thus continuous education to update and support clinicians is also called for. (shrink)

BackgroundAttention deficit hyperactivity disorder is clinically diagnosed; however, quantitative analysis to statistically analyze the symptom severity of children with ADHD via the measurement of head movement is still in progress. Studies focusing on the cues that may influence the attention of children with ADHD in classroom settings, where children spend a considerable amount of time, are relatively scarce. Virtual reality allows real-life simulation of classroom environments and thus provides an opportunity to test a range of theories in a naturalistic and (...) controlled manner. The objective of this study was to investigate the correlation between participants’ head movements and their reports of inattention and hyperactivity, and to investigate how their head movements are affected by different social cues of different sensory modalities.MethodsThirty-seven children and adolescents with and without ADHD were recruited for this study. All participants were assessed for diagnoses, clinical symptoms, and self-reported symptoms. A virtual reality-continuous performance test was conducted under four conditions: control, no-cue, visual cue, and visual/audio cue. A quantitativecomparison of the participants’ head movements was conducted in three dimensions using a head-mounted display in a VR classroom environment. Task-irrelevant head movements were analyzed separately, considering the dimension of movement needed to perform the VR-CPT.ResultsThe magnitude of head movement, especially task-irrelevant head movement, significantly correlated with the current standard of clinical assessment in the ADHD group. Regarding the four conditions, head movement showed changes according to the complexity of social cues in both the ADHD and healthy control groups.ConclusionChildren and adolescents with ADHD showed decreasing task-irrelevant movements in the presence of social stimuli toward the intended orientation. As a proof-of-concept study, this study preliminarily identifies the potential of VR as a tool to understand and investigate the classroom behavior of children with ADHD in a controlled, systematic manner. (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)

Do liberals’ and conservatives’ brain processes differ in moral reasoning? This research explains these groups’ dissimilar moral stances when they face ethical transgressions in business. Research that explores the effects of ideological asymmetry on moral reasoning processes through moral foundations has been limited. We hypothesize two different moral reasoning processes and test them in the South Korean culture. Study 1 uses the neuroscientific method of event-related potentials to explore the dissociable neural mechanisms that underlie Korean liberals’ and conservatives’ moral reasoning (...) processes in business ethical transgressions. Liberals’ early frontal negative-going brain waves showed that they are quick to pass negative judgment by intuitively detecting violations of fairness, while conservatives’ temporoparietal positive-going brain waves showed that they have a higher motivation to respect authority. Both liberals’ and conservatives’ ERP components occur within the first second of the decision-making phase, suggesting the rapid and intuitive nature of moral reasoning processes. Study 2 tests a mediating process and confirms that Korean liberals exhibit the moral engagement strategy, through the fairness foundation. These findings from our interdisciplinary research deepen the knowledge of the complexity of human morality in business ethics research. (shrink)

In dialogue with Jürgen Habermas's communicative ethics, Covenant and Communication constructively explores a covenantal-communicative model of Christian ethics. Author Hak Joon Lee analyzes themes of freedom, equality, and reciprocity in Habermas's theory of communication from the perspective of the Reformed Christian doctrines of covenant and the Trinity.