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

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)

Modern schooling in Korea, which was officially established by law in 1949, is well known for its function as an engine of economic success in modern Korea. Although this fact seems to be world-wid...

This study examines a deep-seated anti-missionary sentiment of Korean theologians and church historians. Chai-Choon Kim and Jong-Sung Rhee were arguably most responsible for popularizing anti-missionary sentiment among Korean Christians. The main reason for the criticisms of both Kim and Rhee against the American Presbyterian Korea missionaries was the supposedly fundamentalist schisms of the Presbyterian Church of Korea in the 1950s, which both Kim and Rhee reasoned to have been originated from their Old Princeton theology. The theological rationale of both Kim (...) and Rhee was the Barthian triumph frame that the Reformed Orthodoxy including the Old Princeton theology, which had been suspected of having a fundamentalist tendency, was overcome by Karl Barth’s Neo-Orthodoxy. These theological anti-missionary criticisms facilitated some younger Korean church historians, especially both Kyung-Bae Min and Man-Yul Lee, to view Korean church history from an anti-missionary, Korean ethnic nationalist perspective. Min emphasizes some seemingly good but anecdotal works of individual Korean native Christians, hence resulting in depreciation of the works of the missionaries and their Korean coworkers. Following Min, Lee goes even further, praising what some individual Korean Christians did for socio-political (anti-establishment) purposes and ignoring what the missionaries and their Korean coworkers did cooperatively for their Korean churches. Those Korean theologians and church historians with quite a strong anti-missionary sentiment might have succeeded in arousing Korean Christians’ ethnic nationalism, but in so doing, they have quite surely deprived Korean Christians of their critically significant and rich ecclesiastical and theological elements which have been originated from the missionaries. (shrink)

This study investigated the neuropsychological profile of college students who engage in binge drinking using comprehensive neuropsychological tests evaluating verbal/non-verbal memory, executive functions, and attention. Groups were determined based on scores on the Korean version of the Alcohol Use Disorder Identification Test and Alcohol Use Questionnaire. There were 79 and 81 participants in the BD and non-BD groups, respectively. We administered the Korean version of the California Verbal Learning Test and Rey-Osterrieth Complex Figure Test to evaluate verbal and non-verbal memory, (...) respectively, and measured executive functions using the Wisconsin Card Sorting Test, Trail-Making Test, Controlled Oral Word Association Test and Stroop Color-Word Test. We administered the d2 test to evaluate attention. Neuropsychological performance was analyzed by multivariate analysis of variance. The BD group showed significantly poorer performance in the long-term free recall condition of the K-CVLT and delayed recall condition of the RCFT and completed significantly fewer categories on the WCST than the non-BD group. In addition, there were significant negative associations among the AUDIT-K total score, AUQ binge score, and long-term free recall score of the K-CVLT. There were significant negative associations between the total AUDIT-K score and delayed recall RCFT score, and between the total AUDIT-K total score and numbers of completed categories on the WCST. These results indicate that college students who participate in BD have difficulties with verbal/non-verbal memory and executive functions, and further suggest that excessive alcohol use could have detrimental effects on the hippocampal-prefrontal circuit even with a relatively short period of alcohol use. (shrink)

With the growing amount of clinical research, regulations and research ethics are becoming more stringent. This trend introduces a need for quality assurance measures for ensuring adherence to research ethics and human research protection beyond Institutional Review Board approval. Audits, one of the most effective tools for assessing quality assurance, are measures used to evaluate Good Clinical Practice and protocol compliance in clinical research. However, they are laborious, time consuming, and require expertise. Therefore, we developed a simple auditing process and (...) evaluated its feasibility and effectiveness. The screening audit was developed using a routine audit checklist based on the Severance Hospital’s Human Research Protection Program policies and procedures. The measure includes 20 questions, and results are summarized in five categories of audit findings. We analyzed 462 studies that were reviewed by the Severance Hospital Human Research Protection Center between 2013 and 2017. We retrospectively analyzed research characteristics, reply rate, audit findings, associated factors and post-screening audit compliance, etc. Investigator reply rates gradually increased, except for the first year. The studies were graded as “critical,” “major,” “minor,” and “not a finding”, based on findings and number of deficiencies. The auditors’ decisions showed fair agreement with weighted kappa values of 0.316, 0.339, and 0.373. Low-risk level studies, single center studies, and non-phase clinical research showed more prevalent frequencies of being “major” or “critical”. Inappropriateness of documents, failure to obtain informed consent, inappropriateness of informed consent process, and failure to protect participants’ personal information were associated with higher audit grade. We were able to observe critical GCP violations in the routine internal audit results of post-screening audit compliance checks in “non-responding” and “critical” studies upon applying the screening audit. Our screening audit is a simple and effective way to assess overall GCP compliance by institutions and to ensure medical ethics. The tool also provides useful selection criteria for conducting routine audits. (shrink)

A common view is that relativism requires tolerance. We argue that there is no deductive relation between relativism and tolerance, but also that relativism is not incompatible with tolerance. Next we note that there is no standard inductive relation between relativism and tolerance—no inductive enumeration, argument to the best explanation, or causal argument links the two. Two inductive arguments of a different sort that link them are then exposed and criticized at length. The first considers relativism from the objective point (...) of view ‘of the universe’, the second from the subjective point of view of the relativist herself. Both arguments fail. There is similarly no deductive relation between absolutism and tolerance—neither entails the other—and no inductive connection of any sort links the two. We conclude that tolerance, whether unlimited or restricted, is independent of both relativism and absolutism. A metaethical theory that says only that there is one true or valid ethical code, or that there is a plurality of equally true or valid ethical codes, tells us nothing about whether we should be tolerant, much less how tolerant we should be. (shrink)

The primary goal of this paper is to investigate the theoretical and methodological applicability of the relevant theories of Marcuse and Foucault to analyzing the relationship between comedic pleasure and the popular media. The researchers investigate the similarities of and the differences between the respective positions of Marcuse and Foucault as they relate to power relations, subjectivity, and practice. Likewise, the methodological applicability of these theorists’ work to a discourse analysis of how media content constructs comedic pleasure is considered. Overall, (...) the present study explored the arrangement and deployment of discourses of comedic pleasure as exploited by the power/knowledge mechanism of the media and the entertainment industry. And, through this discussion, the current study argued that three key statements constitute a discursive framework for the analysis of comedic pleasure in the popular media. (shrink)

Some feminist discourses blame some men for gender inequality, gender domination, and gender-based violence. Some women use such discourse as a perfect scenario to criticize some men’s behavior. Indeed, they usually do so with Oppressed Traditional Masculinities but not with Dominant Traditional Masculinities, who are the men who were violent with those women and with whom some of those women chose to have relationships. However, there have always been men who have been on the side of women and have never (...) committed violence against them. Therefore, New Alternative Masculinities reject being indicated as guilty of the violence committed against women by DTM. Through a communicative approach, applying six semi-structured interviews with a communicative orientation and a communicative data analysis of all information, this article explores both women’s communicative acts that blame OTM for what DTM have done to women and NAM’s reactions to these accusations to stop such blaming to make it possible to overcome hegemonic discourses. (shrink)

The "Feminist Theory Reader" provides a revolutionary new approach to anthologizing the important works in feminist theory by incorporating the voices of women ...

To ensure their survival in natural habitats, plants must recognize and respond to a wide variety of insect herbivores. Aphids and other Hemiptera pose a particular challenge, because they cause relatively little direct tissue damage when inserting their slender stylets intercellularly to feed from the phloem sieve elements. Plant responses to this unusual feeding strategy almost certainly include recognition of aphid salivary components and the induction of phloem‐specific defenses. Due to the excellent genetic and genomic resources that are available for (...) Arabidopsis thaliana (Arabidopsis), this plant was chosen as a model system to study the metabolic and transcriptional responses to infestation by two aphids, Myzus persicae (green peach aphid, a broad generalist) and Brevicoryne brassicae (cabbage aphid, a crucifer‐feeding specialist). Future research on Arabidopsis–aphid interactions will lead to the identification of aphid‐specific elicitors, components of the defense‐signaling pathway, and additional metabolic responses that are induced by aphid infestation. BioEssays 29:871–883, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

This research was focused on investigating why some consumers might support cause-related marketing campaigns for reasons other than personal benefit by examining the influence of moral emotions and cultural orientation. The authors investigated the extent to which moral emotions operate differently across a cultural variable (US versus Korea) and an individual difference variable (self-construal). A survey method was utilised. Data were collected from a convenience sample of US ( n = 180) and Korean ( n = 191) undergraduates. Moral emotions (...) significantly influenced purchase intention for a social-cause product. The influence of an ego-focused moral emotion (i.e., pride) on purchase intention was greater for US than Korean participants. The influence of another-focused moral emotion (i.e., guilt) on purchase intention was greater for high-interdependent participants than for low-interdependent participants. The findings of this research provide important and relevant implications to marketers and policy makers in developing persuasive messages and customer relationship programmes. (shrink)

Using an innovative fabrication technique, eco-friendly faux leather has been newly developed as a green leather alternative for the Chinese and Korean markets. Value–belief–attitude logic drawn from the heuristic-systemic model :621–642, 1998) and value–belief–norm theory :723–743, 1995) is proposed to explicate the consumer acceptance attitudes toward the EFFL product. The findings from the multi-group structural equation modeling analysis of online data support the relevancy of VBA logic in which utilitarian and hedonic value motivate pro-environmental belief, and the EFFL product attributes (...) significantly mediate belief and positive attitude toward the EFFL product. The discrepancies across two countries and two age cohorts are noteworthy when pro-environmental belief and product-related information lead to different consumer VBA processes in specific market segments. This study presents insights which provide novel opportunities for managerial implementations and theoretical advancements in eco-friendly related subjects and issues. (shrink)

Drawing upon the theory of virtue ethics, this study builds a decision tree predictive model to explore the anticipated impact of good traits on socially responsible consumption. Using R statistical software, we generate a classification tree and cross-validate the model on two independent datasets. The results indicate that the virtuous traits of self-efficacy, courage, and self-control, as well as the personality traits of openness and conscientiousness, predict socially responsible purchase and disposal behavior. Remarkably, the largest segment of socially responsible consumers (...) in the study scored high in self-efficacy and openness. This result suggests that marketers should focus on these good traits when creating advertisements to encourage sustainable consumption. Our study contributes to enhancing knowledge about the social and psychological aspects of the sustainability movement and provides a new analytical approach to predicting socially responsible consumption. (shrink)

This study assessed the demographic characteristics of Koreans engaged in leisure sports activities during the COVID-19 pandemic and the differences in their preventive health behaviors and constraints on leisure activities. For this study, the demographic characteristics of 544 leisure sport participants, who were recruited on a nationwide basis, were examined through an online survey. Then, comparisons between groups were performed using independent t-tests, one-way analysis of variance, and multivariate analysis of variance. Women who participated in both indoor and outdoor leisure (...) sports showed higher adoption of health prevention behaviors than their male counterparts, and married individuals who participated in indoor leisure sports showed higher adoption of health prevention behaviors than unmarried participants. Moreover, individuals who participated in both indoor and outdoor leisure sports by themselves had many interpersonal constraints overall, and the group of married individuals who participated in indoor leisure sports showed structural constraints. In conclusion, leisure sports participants have adopted many health prevention behaviors during the COVID-19 pandemic, but this had led to some interpersonal constraints. These results indicate that, in the case of future pandemics, personal and institutional efforts will need to be made to promote participation in leisure sports and prevent excessive social isolation. (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)

In this paper I argue that Confucius’ view of learning in the Analects entails critical thinking. Although he neither specified the logical rules of good reasoning nor theorised about the structure of argument, Confucius advocated and emphasised the importance of critical thinking. For Confucius reflective thinking of two sorts is essential to learning: (1) reflection on the materials of knowledge, in order to synthesise and systemise the raw materials into a whole, and to integrate them into oneself as wisdom; (2) (...) reflection on oneself, (a) in order to ensure that such synthesis, systemisation, and integration proceed in an open-minded, fair and autonomous way, and (b) in order to integrate knowledge with the self, that is, to internalise it until it becomes oneself. (shrink)

In this paper I argue that Confucius' view of learning in the Analects entails critical thinking. Although he neither specified the logical rules of good reasoning nor theorised about the structure of argument, Confucius advocated and emphasised the importance of critical thinking. For Confucius reflective thinking of two sorts is essential to learning: (1) reflection on the materials of knowledge, in order to synthesise and systemise the raw materials into a whole, and to integrate them into oneself as wisdom; (2) (...) reflection on oneself, (a) in order to ensure that such synthesis, systemisation, and integration proceed in an open-minded, fair and autonomous way, and (b) in order to integrate knowledge with the self, that is, to internalise it until it becomes oneself. (shrink)

An energy efficiency scenario (Joint Institute for a Sustainable Energy and Environmental Future) demonstrates that an energy future built on the use of cost-effective, high-efficiency technologies is clearly within the grasp of South Korea and would justify a nuclear power moratorium with significantly lower carbon dioxide emissions. This is a promising result, especially because applications of other sustainable energy options, such as renewables, decentralized technologies, material recycling/reuse, ecologically based land use planning, forest conservation, sustainable agriculture, and redirection of economic development (...) toward an environment-friendly industrial base, are not included in the analysis. Here lies one of the most fundamental policy choices of the newcentury: Will we build a sustainable energy and environmental future, or will we send forward the burdens and risks of a policy regime that is unwilling to value the future beyond the satisfaction of short-term interests and convenience? It is a critical time for South Korean policy making. (shrink)

The purpose of this study was to identify how older Korean people seek information and their desire to participate in decision making about their health care. A total of 165 elderly people living in Seoul, South Korea, participated in the study. Data were collected during individual interviews using the Autonomy Preference Index. The mean information-seeking score was high. The mean score for their desire to participate with a physician in decision making was lower, but this was higher when family members (...) were involved. The study indicates that many older people want to receive information about their health care. Families (or guardians), as well as older people themselves, should be included in the decision-making process. Nurses can encourage older people to express their wishes, while treating each individual with respect. (shrink)

This study assessed the knowledge and perception of human biological materials (HBM) and biorepositories among three study groups in South Korea. The relationship between the knowledge and the perception among different groups was also examined by using factor and regression analyses. In a self‐reporting survey of 440 respondents, the expert group was found more likely to be knowledgeable and positively perceived than the others. Four factors emerged: Sale and Consent, Flexible Use, Self‐Confidence, and Korean Bioethics and Biosafety Action restriction perception. (...) The results indicate that those who are well aware of the existence of biobanks were more positively inclined to receive the Sale and Consent perception. As a result of the need for high quality HBMs and the use of appropriate sampling procedures for every aspect of the collection and use process, the biorepository community should pay attention to ethical, legal, and policy issues. (shrink)

What Aristotle's main concern is in Metaphysics H 6 has long puzzled commentators. In this paper I argued for a novel, deflationary interpretation of that chapter: Aristotle's main concern is to argue for the causeless unity of the definitions of form and of composite substance. The problem he is grappling with arises from a combination of speaking about the parts of form and the parts of composite substances, and the principle that parts of a whole need a unifying cause in (...) order to be one and not many. If both form and composite particulars need a unifying cause, form cannot be primary substance, and composite substances, as composites of form and matter, cannot be true unities, but must be mere heaps of material parts which need a third unifying cause. Aristotle argues that although and seemingly threaten his theory of substance with incoherence, the problem can be easily solved if the unity of definitions of form and of composite substance are properly seen as causeless. In the course of clarifying and defending this reading of H6, a number of alternative interpretations are exposed and criticized. (shrink)