In the age of artificial intelligence, writing machines or robot authors have already begun to produce narrative texts in a variety of genres, including short stories and poetry, as well as journalistic articles. This article is based on the prospect that the narrative ecosystem is in a transitional period of decisive disconnection as it enters the era of artificial intelligence. The primary force driving this transition is the formidable execution of artificial intelligence algorithms, which fully automate narrative communication and narrative (...) works. This article attempts to lay the groundwork for building a new paradigm of post-narrativity through a critical examination of several detailed themes in narrative semiotics and non-anthropocentric narratology. The process of narrative creation based on artificial intelligence algorithms is a key condition that constitutes post-narrativity. This presupposes a non-anthropocentric view. In the landscape of post-narrativity, human writers, paper books, computer screens, and invisible narrative algorithms are all agents with equal influence. Automated narrative production by algorithms accelerates the repositioning of other existing media and actors, and changes the narrative ecosystem by incorporating new elements into activities such as production, distribution, and reception of narratives. (shrink)

Despite the prevailing discourses on the importance of top management ethical leadership, related theoretical and empirical developments are lacking. Drawing on institutional theory, we propose that top management ethical leadership contributes to organizational outcomes by promoting firm-level ethical and procedural justice climates. This theoretical framework was empirically tested using multi-source data obtained from 4,468 employees of 147 Korean companies from various industries. The firm-level analysis shows that top management ethical leadership significantly predicts ethical climate, which then results in procedural justice (...) climate that fully mediates the effects of top management ethical leadership on two organizational outcomes, namely, firm-level organizational citizenship behavior and firm financial performance. The present study provides a plausible theoretical account and empirical validation of a mechanism through which top management ethical leadership enhances organizational performance. (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)

Recent data indicate that under a specific posthypnotic suggestion to circumvent reading, highly suggestible subjects successfully eliminated the Stroop interference effect. The present study examined whether an optical explanation could account for this finding. Using cyclopentolate hydrochloride eye drops to pharmacologically prevent visual accommodation in all subjects, behavioral Stroop data were collected from six highly hypnotizables and six less suggestibles using an optical setup that guaranteed either sharply focused or blurred vision. The highly suggestibles performed the Stroop task when naturally (...) vigilant, under posthypnotic suggestion not to read, and while visually blurred; the less suggestibles ran naturally vigilant, while looking away, and while visually blurred. Although visual accommodation was precluded for all subjects, posthypnotic suggestion effectively eliminated Stroop interference and was comparable to looking away in controls. These data strengthen the view that Stroop interference is neither robust nor inevitable and support the hypothesis that posthypnotic suggestion may exert a top-down influence on neural processing. (shrink)

In light of the dramatic growth of Chinese learners worldwide and a need for cross-linguistic research on Chinese literacy development, this study drew upon theories of visual complexity effect (Su & Samuels, 2010) and dual-coding processing (Sadoski & Paivio, 2013) and investigated a) the effects of character properties (i.e., visual complexity and radical presence) on character acquisition and b) the relationship between individual learner differences in radical awareness and character acquisition. Participants included adolescent English-speaking beginning learners of Chinese in the (...) U.S. Following Kuo et al. (2014), a novel character acquisition task was used to investigate the process of acquiring the meaning of new characters. Results showed that a) characters with radicals and with less visual complexity were easier to acquire than characters without radicals and with greater visual complexity; and b) individual differences in radical awareness were associated with the acquisition of all types of characters, but the association was more pronounced with the acquisition of characters with radicals. Theoretical and practical implications of the findings were discussed. (shrink)

Background: Infectious disease outbreaks such as COVID-19 and MERS pose a major threat to healthcare workers' physical and mental health. Studies exploring the positive changes gained from adapting to traumatic events, known as post-traumatic growth, have attracted much attention. However, it is unclear which factors or experiences lead to PTG among HCWs. The purpose of this mixed-method study was to investigate factors associated with PTG among HCWs who experienced the MERS outbreak in South Korea, and fully describe their experience of (...) developing PTG.Methods: Quantitative data from 78 participants were collected using psychometric tools for Psychological distress, Resilience, and Support for coping, and Post-traumatic growth. Qualitative interviews were conducted with seven nurses. Data were analyzed using the qualitative content analysis method according to the sub-themes of resilience, which was the main factor associated with PTG.Results: We found resilience to have a significant impact on PTG. Thus the qualitative interviews were analyzed using the core concepts of resilience. Qualitative interviews with nurses illustrated how participants experienced the development of resilience in terms of its sub-factors: hardiness, persistence, optimism, and support.Conclusion: HCWs who endured the MERS outbreak showed high levels of PTG, and the analysis of the interview data provided a fuller understanding on the experience of remaining resilient and developing PTG. These results provide practical and pragmatic information helpful for developing intervention strategies and protocols that can help HCWs transform adversity into growth and development. (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)

A recent paradigm shift in music research has allowed scholars to examine the macro- and micro-processes taking place within musical performance and underlying cognitive processes. Tying in with phenomenological theories of embodied perception and cognition, this paper focuses on bodily musical activity relevant to the acquisition of instrumental musical skills—the process of learning music. Dynamic interaction with musical instruments, accompanied by the interplay of action and passion, involves body image and body schema, whose status oscillates in different phases of the (...) acquisition of instrumental musical skills; this interaction allows humans to direct attention from their bodily states—the proximal—to the quality of musical sounds and a unity of musical experience—the distal. It is thus argued that shaping music by means of playing a musical instrument can be conceived of as an embodied process, of understanding the forms of one’s own experience as related to the musical world that is created by one’s bodily activity. (shrink)

This paper elucidates and rationalizes the ethical governance system for healthcare AI research, as outlined in the ‘Research Ethics Guidelines for AI Researchers in Healthcare’ published by the South Korean government in August 2023. In developing the guidelines, a four-phase clinical trial process was expanded to six stages for healthcare AI research: preliminary ethics review (stage 1); creating datasets (stage 2); model development (stage 3); training, validation, and evaluation (stage 4); application (stage 5); and post-deployment monitoring (stage 6). Researchers identified (...) similarities between clinical trials and healthcare AI research, particularly in research subjects, management and regulations, and application of research results. In the step-by-step articulation of ethical requirements, this similarity benefits from a reliable and flexible use of existing research ethics governance resources, research management, and regulatory functions. In contrast to clinical trials, this procedural approach to healthcare AI research governance effectively highlights the distinct characteristics of healthcare AI research in research and development process, evaluation of results, and modifiability of findings. The model exhibits limitations, primarily in its reliance on self-regulation and lack of clear delineation of responsibilities. While formulated through multidisciplinary deliberations, its application in the research field remains untested. To overcome the limitations, the researchers’ ongoing efforts for educating AI researchers and public and the revision of the guidelines are expected to contribute to establish an ethical research governance framework for healthcare AI research in the South Korean context in the future. (shrink)

ObjectivesHostile attribution bias is reportedly common from non-clinical population to those with serious mental illness, such as schizophrenia, and is known to be closely related to theory of mind. This study aimed to investigate whether ToM skills mediate the relationship among neurocognitive ability, personality traits, and attribution bias.MethodsA total of 198 non-clinical youths were recruited. To assess their neurocognitive ability and ToM skills, the participants were asked to complete Raven’s Standard Progressive Matrices and the Korean version of the Reading the (...) Mind in Eyes Test. To determine their personality traits, the Eysenck Personality Questionnaire and interpersonal reactivity index were used. To evaluate hostile attribution bias, the Ambiguous Intentions Hostility Questionnaire was administered. Path analysis and bias-corrected percentile bootstrap methods were used to estimate model fit and the parameters of the mediating effects.ResultsBased on model comparison, the best model characterized two direct pathways from psychoticism and the K-RMET to hostility attribution bias and three indirect pathways, wherein SPM, perspective taking, and psychoticism influenced hostile attribution bias through K-RMET. The final model fit indices were good [x2/df = 1.126; comparative fit index = 0.996; root mean square error of approximation = 0.026; standard root mean square residual = 0.026 and Akaike information criterion = 28.251] and the K-RMET fully mediated the association between SPM, perspective taking, psychoticism, and hostile attribution bias.ConclusionThe main findings suggested that ToM skills, such as the RMET, play an important role in explaining the relationship among neurocognitive ability, personality traits, and hostile attribution bias. ToM skills and a remediation strategy may need to be developed to balance the enhanced hostility bias that underlies the paranoia. (shrink)

Over the past decade AIDS research has turned toward the use of pharmacology in HIV prevention, including pre-exposure prophylaxis (PrEP): the use of HIV medication as a means of preventing HIV acquisition in those who do not have it. This paper explores the contradictory reasons offered in support of PrEP—to empower women, to provide another risk-reduction option for gay men—as the context for understanding the social meaning of the experimental trials that appear to show that PrEP works in gay men (...) and heterosexual couples but not single women. The PrEP debates reveal the different ideas about “demedicalization” in the earlier gay health and women’s health movements and highlight the relationship between health activism and critique of research ethics in the context of a global pharmaceutical market. (shrink)

To cope with economic globalization and improve the competitiveness of transnational start-ups, the impact of the work environment and innovation behavior on corporate performance of multinational new ventures is analyzed. First, a model of the interaction among environment, innovation behavior, and enterprise performance is proposed. Then, 296 transnational start-ups in coastal areas are surveyed, and the model results are analyzed. Finally, a series of results are obtained. The results show that from the perspective of psychology, work dynamic organizational learning environment (...) has a positive impact on enterprise performance, and resource environment has a significant positive impact on enterprise performance. Strategic environment also positively affects enterprise performance. Therefore, the working environment of multinational new ventures has a positive impact on firm performance, and the mediating function between the working environment and firm performance is firm innovation behavior. With the research to achieve enterprise innovation of multinational new ventures by improving their response to the dynamic environment, the corporate performance has been greatly promoted, and finally, the new ventures would participate in the international market competition. (shrink)

This longitudinal study examined how nursing students' moral judgment changes after they become qualified nurses working in a hospital environment. The sample used was a group of 80 nursing students attending a university in Suwon, Korea, between 2001 and 2003. By using a Korean version of the Judgment About Nursing Decisions questionnaire, an instrument used in nursing care research, moral judgment scores based on Ketefian's six nursing dilemmas were determined. The results were as follows: (1) the qualified nurses had significantly (...) higher idealistic moral judgment scores than the nursing students; (2) the qualified nurses showed significantly higher realistic moral judgment scores than the nursing students; and (3) when comparing idealistic and realistic moral judgment scores, both the qualified nurses and the nursing students had higher scores for idealistic moral judgment. Further study is recommended to examine changes in moral judgment. (shrink)

This book engages in cross-tradition scholarship, investigating the processes associated with cultivating or nurturing the self in order to live good lives. Both Ancient Chinese and Greek philosophers provide accounts of the life lived well: a Confucian junzi, a Daoist sage and a Greek phronimos. By focusing on the processes rather than the aims of cultivating a good life, an international team of scholars investigate how a person develops and practices a way of life especially in these two traditions. They (...) look at what is involved in developing practical wisdom, exercising reason, cultivating equanimity and fostering reliability. Drawing on the insights of thinkers including Plato, Confucius, Han Fei and Marcus Aurelius, they examine themes of harmony, balance and beauty, highlight the different concerns of scepticism across both traditions, and discuss action as an indispensable method of learning and, indeed, as constitutive of self. The result is a valuable collection opening up new lines of inquiry in ethics, demonstrating the importance of philosophical ideas from across cultural traditions. (shrink)

One of the most salient objections against paternalism is that it is motivated by a negative judgment about other people’s capacity to advance their own goals and interests. Such a negative judgment, according to this objection, is morally wrong because it denies others the status of moral equals who can rationally set and pursue their own conception of the good. Despite the popularity of this objection, I argue that it misfires because rendering a negative judgment about others’ capacities does not (...) deny them equal moral status when there is sufficient _evidence_ for that judgment. However, I argue that in order to determine if there is sufficient evidence of the agent’s incapacity, we must understand the agent’s reasons for action through a rational discursive exchange with them, instead of taking perceived facts about their behavior as sufficient grounds for a negative (or positive) judgment of their capacities. In fact, I argue that if the outcome of the discursive exchange supports a negative judgment of the agent’s capacities, there is a _pro tanto_ case in favor of paternalistic interference. (shrink)

Korean biobanks are now adapting to integrate the new paradigm of precision medicine into their fundamental role of promoting health technology. Since the enactment of Bioethics and Safety Act in 2004, the Republic of Korea has developed a regulatory framework that reflects ethical principles. However, the existing regulation of biobanks has recently proven to be limited in responding to newer ethical and legal issues that have arisen. First, as there is an emerging trend for human biospecimens to be stored, managed (...) and distributed as digitalized data, the current role of the Distributive Review Committee may become less important compared to the Data Access Committee. Second, even if public health data is anonymized, the risk of identifiability is growing. This makes a third point relevant, informed consent is crucial to respect the autonomy of patients and research subjects, but current consent rules need to change to reflect the interactive and dynamic communication process, in which information and communication technology plays an increasingly prominent role. Fourth, even though data sharing for research is expected to be altruistic and the sale of human biospecimens and genome data remains prohibited, data sharing practices have become more complicated and are closer to commercial use and commercialization. Given these challenges, there is a pressing need for continuing and deeper deliberation in order to develop a more comprehensive and responsive governance framework. (shrink)

Bien que le rôle dans l’expérience esthétique des kinesthèses remontant au cycle action-perception du processus de création artistique soit reconnu par la théorie neurocognitive de l’esthétique, on n’a pas encore dissocié les contributions respectives des sensations corporelles et de la simulation interne, deux dimensions distinguées par T. Lipps. Pour désambiguer la part de l’empathie kinesthésique dans l’expérience esthétique de la musique, on a comparé les enregistrements des micro-gestes d’exécution de musiciens avec leur compte-rendu de l’expressivité musicale éprouvée lors de l’observation (...) et de l’exécution de morceaux de musique. (shrink)

According to T.M. Scanlon, the core idea of contractualism consists in the claim that what we are morally required to do is conceptually grounded in the value of living in “relations of mutual recognition” with others. Specifically, Scanlon's contractualist idea of “living in relations of mutual recognition with others” requires that one act only in ways that cannot be reasonably rejected by all of those affected, according to the results of a hypothetical reflection conducted within one's own mind. I claim, (...) however, that Scanlon is mistaken to rely on a single individual's hypothetical reflection (monological reflection) to determine what no one affected could reasonably reject. Instead, following Jürgen Habermas, I claim that we must engage in actual dialogue with all who stand to be affected, in order to live in relations of mutual recognition with others. (shrink)

Supporters of paternalistic policies argue that interference with risky or dangerous choices for citizens’ own good is permissible, as long as those choices are caused by cognitive irrationality or ignorance. Yet, some liberal thinkers argue that despite human irrationality, paternalistic policies are still wrong because they fail to respect citizens as moral equals. I argue that actually both views are mistaken about what respect for citizens requires, because they conceptualize the citizens’ interests from the wrong standpoint. In order for citizens (...) to be respected as equals, I argue that citizens’ interests must be defined from a joint (second-person) standpoint which is constructed through a dialogical process between policymakers and citizens oriented towards mutual understanding. Furthermore, I argue that engaging citizens in such a dialogue is a distinctive paternalistic intervention in its own right, which unlike other kinds of paternalistic intervention, is compatible with respect for citizens as equals. (shrink)

Supporters of paternalistic policies argue that interference with risky or dangerous choices for citizens’ own good is permissible, as long as those choices are caused by cognitive irrationality or ignorance. Yet, some liberal thinkers argue that despite human irrationality, paternalistic policies are still wrong because they fail to respect citizens as moral equals. I argue that actually both views are mistaken about what respect for citizens requires, because they conceptualize the citizens’ interests from the wrong standpoint. In order for citizens (...) to be respected as equals, I argue that citizens’ interests must be defined from a joint (second-person) standpoint which is constructed through a dialogical process between policymakers and citizens oriented towards mutual understanding. Furthermore, I argue that engaging citizens in such a dialogue is a distinctive paternalistic intervention in its own right, which unlike other kinds of paternalistic intervention, is compatible with respect for citizens as equals. (shrink)

Supporters of paternalistic policies argue that interference with risky or dangerous choices for citizens’ own good is permissible, as long as those choices are caused by cognitive irrationality or ignorance. Yet, some liberal thinkers argue that despite human irrationality, paternalistic policies are still wrong because they fail to respect citizens as moral equals. I argue that actually both views are mistaken about what respect for citizens requires, because they conceptualize the citizens’ interests from the wrong standpoint. In order for citizens (...) to be respected as equals, I argue that citizens’ interests must be defined from a joint (second-person) standpoint which is constructed through a dialogical process between policymakers and citizens oriented towards mutual understanding. Furthermore, I argue that engaging citizens in such a dialogue is a distinctive paternalistic intervention in its own right, which unlike other kinds of paternalistic intervention, is compatible with respect for citizens as equals. (shrink)

Supporters of paternalistic policies argue that interference with risky or dangerous choices for citizens’ own good is permissible, as long as those choices are caused by cognitive irrationality or ignorance. Yet, some liberal thinkers argue that despite human irrationality, paternalistic policies are still wrong because they fail to respect citizens as moral equals. I argue that actually both views are mistaken about what respect for citizens requires, because they conceptualize the citizens’ interests from the wrong standpoint. In order for citizens (...) to be respected as equals, I argue that citizens’ interests must be defined from a joint (second-person) standpoint which is constructed through a dialogical process between policymakers and citizens oriented towards mutual understanding. Furthermore, I argue that engaging citizens in such a dialogue is a distinctive paternalistic intervention in its own right, which unlike other kinds of paternalistic intervention, is compatible with respect for citizens as equals. (shrink)

The expansion of the higher education system and the rationalization of universities in South Korea, while broadly following the global patterns, reflect the characteristics of the national political system. We show the rapid growth of universities and document core organizational changes among universities: the elaboration of faculty performance evaluation rules, the expansion and differentiation of central administrations, and the emergence of engagement in vision statements. These changes, constructing universities as organizational actors, parallel the changes in higher education systems elsewhere. However, (...) the uniqueness of the Korean experience lies with the role of the state as a catalyst guiding the overall direction and the structure and strategy of universities. We discuss the implications of our research for the rationalization of universities in a highly centralized system. (shrink)

Tumor‐infiltrating lymphocyte (TIL) therapy is a promising approach for treating refractory or advanced solid cancers by using autologous TILs harvested from cancer tissues. Despite the heterogeneity of cancer, TIL therapy can potentially produce a positive therapeutic response, including complete remission.After decades of research on lymphocyte functions, culture/expansion methods, therapeutic protocols, and multiple clinical trials, TIL therapy has finally reached a stage where it can be formally approved for clinical use.TIL therapy is expected to hold a unique position among anti‐cancer therapeutic (...) options as a standard intervention. To successfully introduce TIL therapy into clinical settings, there is a need to expand therapeutic indications and set up the best protocols for cancer tissue sampling and manufacturing, and related clinical trials. Moreover, studies on next‐generation TIL therapy have already begun, and post‐approval real‐world data will promote and support further research. (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)

A tic disorder (TD) is a neurodevelopmental disorder characterized by tics, which are repetitive movements and/or vocalizations that occur due to aberrant sensory gating. Its pathophysiology involves dysfunction in multiple parts of the cortico-striato-thalamo-cortical circuits. Spontaneous brain activity during the resting state can be used to evaluate the baseline brain state, and it is associated with various aspects of behavior and cognitive processes. Theta–gamma coupling (TGC) is an emerging technique for examining how neural networks process information through interactions. However, the (...) resting-state TGC of patients with TD and its correlation with cognitive function have not yet been studied. We investigated the resting-state TGC of 13 patients with TD and compared it with that of 13 age-matched healthy children. The participants underwent resting-state electroencephalography with their eyes closed. At the global level, patients with TD showed a significantly lower resting-state TGC than healthy children. Resting-state TGC with the eyes closed was significantly negatively correlated with the attention quotient calculated for omission errors in a selective visual attention test. These findings indicate that the resting-state brain network, which is important for the attentional processing of visual information, is dysfunctional in patients with TD. Additionally, these findings support the view that TGC reflects information processing and signal interactions at the global level. Patients with TD may have difficulty gating irrelevant sensory information in the resting state while their eyes are closed. (shrink)

River water pollution by wastewater can cause significant negative impact on the aquatic sustainability. Hence, accurate modeling of this complicated system and its cost-effective treatment and reuse decision is very important because this optimization process is related to economic expenditure, societal health, and environmental deterioration. In order to optimize this complex system, we may consider three treatment or reuse options such as microscreening filtration, nitrification, and fertilization-oriented irrigation on top of two existing options such as settling and biological oxidation. The (...) objective of this environmental optimization is to minimize the economic expenditure of life cycle costs while satisfying the public health standard in terms of groundwater quality and the environmental standard in terms of river water quality. Particularly, this study improves existing optimization model by pinpointing the critical deficit location of dissolved oxygen sag curve by using analytic differentiation. Also, the proposed formulation considers more practical constraints such as maximal size of irrigation area and minimal amount of filtration treatment process. The results obtained by using an evolutionary algorithm, named a parameter-setting-free harmony search algorithm, show that the proposed model successfully finds optimal solutions while conveniently locating the critical deficit point. (shrink)

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)

Both Ancient Chinese and Greek philosophers provide accounts of the life lived well: a Confucian junzi, a Daoist sage and a Greek phronimos. Cultivation in Early China and Ancient Greece engages in comparative, cross-tradition scholarship and investigates the processes associated with cultivating or nurturing the self in order to live such lives. -/- By focusing on the processes rather than the aims of cultivating a good life, an international team of scholars investigate how a person develops and practices a way (...) of life. They look at what is involved in developing practical wisdom, exercising reason, cultivating equanimity and fostering reliability. Using the thought of those thinkers central to both traditions, including Plato, Confucius, Han Fei and Marcus Aurelius, they examine themes of harmony, balance and beauty, and highlight the different concerns of scepticism across both traditions. They also discuss the action of doing as an indispensable method of learning. As a result, Cultivation in Early China and Ancient Greece is a valuable collection opening up new lines of inquiry in ethics and demonstrating the importance of drawing on philosophical ideas from across cultural traditions. (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)