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)

From the perspective of the system of systems development, system-level functional testing is required for designing subsystems. This study utilizes modeling and simulation techniques to analyze the operational behaviors of the subsystems and confirm data communication between them. The targeted system in the study is a naval combat system, which is a typical type of defense cyber-physical system. Three types of models were designed for the simulation testing of the NCS: a combat-management model for simulating the overall computational activities, physical (...) models to confirm the intrasubsystem behaviors, and data integration models to test the intersubsystem communications. These models are realized with the Model-View-ViewModel design pattern, which strongly facilitates graphical user interfaces being decoupled from model logic and data. We consider underwater combat scenarios as an application. Six significant physical subsystems within the NCS are simulated and tested: a ship-steering system, an inertial navigation system, a global navigation satellite system, a periscope, sonar systems, and a plotting board. We expect that the proposed work will play a principal role when analyzing the behaviors and communications of defense CPSs and providing an environment for functional testing as a digital twin. (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)

In this paper, I propose an interpretation of the Confucian concept of li or Ritual Propriety, and suggest a new philosophy of action and mind on the basis of the concept. To achieve this aim, I fo...

In this paper, I propose an interpretation of the Confucian concept of li or Ritual Propriety, and suggest a new philosophy of action and mind on the basis of the concept. To achieve this aim, I fo...

This study examines the participation and interaction of relevant individuals in the process of developing an accounting standard for South Korea’s emission trading scheme (ETS). Despite the enormous accounting implications of such schemes, there is a paucity of research on the development and application of ETS accounting. Ulrich Beck’s and Anthony Giddens’s risk society framework is utilised to scrutinise the process of setting accounting standards—from the agenda-setting stage all the way to the final publication of the standard. In this case (...) study, we take an interpretive approach in analysing the rich data collected through face-to-face interviews with prominent standard-setters, accounting experts and representatives of industry and government. Participant observation and relevant documents were also considered. The findings highlight the political nature of accounting standard-setting and identify the risks and responsibilities of the key agents in the process along with the means of sub-political action taken to influence decisions. We reveal that the agents involved in standard-setting attempted to balance their anthropocentric priorities with ecocentric responsibilities and prioritised the production of a standard with minimal impact on economic, reputational, and operational risk. Having authority as a standard-setter, referring frequently to precedents and, perhaps most importantly, engaging actively with the stakeholders throughout the process seem to have contributed to a widely accepted standard, which can serve as a benchmark for future attempts to factor in ETSs. (shrink)

This study investigated the usefulness of the six-item Stress and Anxiety to Viral Epidemics scale and the Coronavirus Anxiety Scale as tools to assess anxiety related to coronavirus disease in cancer patients. A total of 221 patients with cancer responded to an anonymous online questionnaire between 15 July and 15 August 2020. The functional impairment of the patients was assessed using the Work and Social Adjustment Scale, and the SAVE-6 and CAS were also applied. Among these 221 cancer patients, 110 (...) had SAVE-6 scores ≥ 15 and 21 had CAS scores ≥ 5. Within the study population, 104 and 29 patients had WSAS scores ≥ 11 and ≥ 21, respectively. The correlations between the SAVE-6 and WSAS and CAS scores were statistically significant. The cut-off for the SAVE-6 was 15 points, while that for the WSAS was 11. Our results suggested that the SAVE-6 and CAS could be used to evaluate moderate and severe degrees of functional impairment related to mental health, respectively, in cancer patients during viral epidemics. (shrink)

Previous studies have used various external variables and parameters as well as moderator variables such as emotional intelligence have been to understand emotional labor and its related problems. However, a comprehensive model to study such variables’ correlations with each other and their overall effect on emotional labor has not yet been established. This study used a structural equation model to understand the relationship between employees’ expression of emotional labor and perception of customer feedbacks. The study also looked at how the (...) perception of customer feedback affects emotional exhaustion in order to understand how emotional exhaustion affects job satisfaction and turnover intentions. Further, in order to fully understand the effects of emotion on emotional labor at the service contact points, this study developed and tested a model of emotional labor with 4 factors of emotional intelligence as moderating factors. 579 emotional labor workers in service industries in the U.S. were collected and 577 valid survey results have been analyzed. The result shows that there exists moderating effects of emotional intelligence on how employees’ Deep Acting and Surface Acting recognize customers’ reactions, both positive and negative, that would affect employees’ Emotional Exhaustion and Job Satisfaction, and hence, Turnover Intention. The result suggests that employees with better understanding of their own emotions, although they are more likely to recover from emotional exhaustion, experience a greater negative effect when there is a discrepancy between what they feel and how they should act. (shrink)

John F. Henry is an eminent economist who has made important contributions to heterodox economics drawing on Adam Smith, Karl Marx, Thorstein Veblen, and John Maynard Keynes. His historical approach offers radical insights into the evolution of ideas (ideologies and theories) giving rise to and/or induced by the changes in capitalist society. Essays collected in this festschrift not only evaluate John Henry's contributions in connection to Marx's and Veblen's theories, but also apply them to the socio-economic issues in the 21st (...) century. In Part I leading heterodox economists in the traditions of Marxism, Post Keynesianism, and Institutionalism critically examine Marx's and Veblen's theoretical frameworks (and their connections to each other) that have become the foundations of heterodox economics. Chapters in Part II showcase alternative theoretical explanations inspired by Marx, Veblen, and Henry. Topics in this Part include financial crisis, financialization, capital accumulation, economics teaching, and the historical relationship between money and class society. Part III is devoted to John Henry's heterodox economics encapsulated in his "farewell" lecture, interview, and bibliography. Essays in this book, individually and collectively, make an important point that the history of economic thought (or historical analysis of economic theory and policy) is an integral part of developing heterodox economics as an alternative theoretical framework. Anyone who is troubled by the recurring failure of capitalism as well as mainstream economics will find this book well worth reading. (shrink)

Background Nurses providing care to patients with end-of-life or terminal illnesses often encounter ethically challenging situations leading to moral distress. However, existing quantitative studies have examined moral distress using instruments that address general clinical situations rather than those specific to end-of-life care. Furthermore, qualitative studies have often been limited to participants from a single unit or those experiencing moral distress-induced circumstances. A comprehensive and integrated understanding of the overarching process of moral distress is vital to discern the unique circumstances surrounding (...) end-of-life care and its consequential impacts. Research objectives To explore the moral distress experiences of nurses who are frequently involved in caring for patients with end-of-life or terminal illnesses and apply it to two existing theories: the model of moral distress and the ecological model. Research design A qualitative descriptive approach was employed. Participants and research context Seven focus group interviews involving 30 nurses were performed. The subsequent transcriptions underwent rigorous content analysis. Ethical considerations We obtained Institutional Review Board approval from a university. Focus group interviews were conducted with nurses who agreed to participate and signed the consent form. Findings The moral distress-inducing factors and nurses’ perceived impact of moral distress were identified and categorized based on moral distress theories and ecological models. A total of 15 categories and 30 subcategories across the following 4 domains were derived: (1) intrapersonal, (2) interpersonal, (3) organizational, and (4) structural factors. Conclusions End-of-life-specific circumstances induced moral distress among nurses, with both negative and positive impacts identified. Effective organizational and policy support is essential to manage conflicts, form a healthy organizational culture, provide training, and prevent unnecessary expenses due to the negative consequences of moral distress. (shrink)

Background:Academic ethical awareness is an important aspect especially for nursing students who will provide ethical nursing care to patients in future or try to tread the path of learning toward professional acknowledgement in nursing scholarship.Purpose:The purpose of this study was to explore academic ethical awareness and its related characteristics among undergraduate nursing students.Methods:This study commenced the survey with cross-sectional, descriptive questions and enrolled convenient samples of 581 undergraduate nursing students from three universities in South Korea. It was investigated with structured (...) questionnaires including general characteristics and academic ethical awareness related.Ethical considerations:This study was reviewed and approved by the Institutional Review Board at National University.Findings:Academic ethical awareness was the highest regarding behaviors violating the respect or confidentiality of patients and cheating on exams, while it was the lowest for inappropriate behaviors in class. From the result of general characteristics difference, male students showed higher score than female students in relative; first-year students showed higher score than other year students; the higher score was rated from students who were highly satisfied with their major than the other not satisfied with their major; and students with low academic stress showed higher ethical awareness score than persons with higher stress.Conclusion:Personal behaviors were rated with low ethical awareness in relative, but items related to public rules and actual effects on patients or others were rated with higher score. Nursing satisfaction and academic stress are main factors on ethical awareness. To improve overall ethical awareness level of nursing students, it is required to provide more education about the importance of personal behaviors in class and need to improve the understanding of how it will be connected with future situation and effect. (shrink)

Algorithms increasingly make managerial decisions that people used to make. Perceptions of algorithms, regardless of the algorithms' actual performance, can significantly influence their adoption, yet we do not fully understand how people perceive decisions made by algorithms as compared with decisions made by humans. To explore perceptions of algorithmic management, we conducted an online experiment using four managerial decisions that required either mechanical or human skills. We manipulated the decision-maker, and measured perceived fairness, trust, and emotional response. With the mechanical (...) tasks, algorithmic and human-made decisions were perceived as equally fair and trustworthy and evoked similar emotions; however, human managers' fairness and trustworthiness were attributed to the manager's authority, whereas algorithms' fairness and trustworthiness were attributed to their perceived efficiency and objectivity. Human decisions evoked some positive emotion due to the possibility of social recognition, whereas algorithmic decisions generated a more mixed response – algorithms were seen as helpful tools but also possible tracking mechanisms. With the human tasks, algorithmic decisions were perceived as less fair and trustworthy and evoked more negative emotion than human decisions. Algorithms' perceived lack of intuition and subjective judgment capabilities contributed to the lower fairness and trustworthiness judgments. Positive emotion from human decisions was attributed to social recognition, while negative emotion from algorithmic decisions was attributed to the dehumanizing experience of being evaluated by machines. This work reveals people's lay concepts of algorithmic versus human decisions in a management context and suggests that task characteristics matter in understanding people's experiences with algorithmic technologies. (shrink)

Public figures’ transgressions attract considerable media attention and public interest. However, little is understood about the impact of celebrity endorsers’ transgressions on associated brands. Drawing on research on moral reasoning, we posit that consumers are not always motivated to separate judgments of performance from judgments of morality or simply excuse a wrongdoer. We propose that consumers also engage in moral coupling, a distinct moral reasoning process which allows consumers to integrate judgments of performance and judgments of morality. In three studies, (...) we demonstrate that moral coupling is prevalent and has unique predictive utilities in explaining consumers’ evaluation of the transgressor. We also show that transgression type has a significant impact on consumers’ choice of moral reasoning strategy. Finally, we demonstrate that consumers’ support for a brand endorsed by a transgressor is a direct function of moral reasoning choice. Findings suggest that public figure’s immoral behavior and its spillover to an extended brand is contingent on consumers’ moral reasoning choices. (shrink)

We develop an approach to the longstanding conjecture of Kierstead concerning the character of strongly nontrivial automorphisms of computable linear orderings. Our main result is that for any η-like computable linear ordering, such that has no interval of order type η, and such that the order type of is determined by a -limitwise monotonic maximal block function, there exists computable such that has no nontrivial automorphism.

Faced with the choice between saving one person and saving two others, what should we do? It seems intuitively plausible that we ought to save the two, and many forms of consequentialists offer a straightforward rationale for the intuition by appealing to interpersonal aggregation. But still many other philosophers attempt to provide a justification for the duty to save the greater number without combining utilities or claims of separate individuals. I argue against one such attempt proposed by Iwao Hirose. Despite (...) being consequentialist, his argument is aggregation-free since it relies on a non-aggregative value judgement method, instead of interpersonal aggregation, to establish that (other things being equal) a state of affairs is better when more people survive therein. I do not take issue with its consequentialist element; rather, I claim that there is no good reason to adopt the method in question, and thus no good reason to be moved by his argument overall. What we are in search of is not merely a logically possible method that can produce the conclusion that we already want, but one that we have good reason to adopt. Hirose's argument elegantly demonstrates how it could possibly be true that it is right to save the greater number; but it fails to show that we have reason to believe so - even when we do not combine the interests of different individuals. (shrink)

Intentional weight loss can increase health risk in the long‐term, despite short‐term benefits, because human adipose tissue is widely contaminated with various lipophilic environmental contaminants, especially persistent organic pollutants (POPs). Recently, chronic exposure to low POPs has emerged as a new risk factor for common metabolic diseases and cardiovascular diseases. The amount of POPs released from adipocytes to the circulation increases during weight loss, thereby increasing POPs exposure of other critical organs. Possible harmful effects due to release of POPs during (...) weight loss are opposite to those usually expected from losing weight. It is speculated that this tradeoff can explain recent puzzling findings on intensive weight loss. The presence of POPs in adipose tissue adds a challenge to weight management and an optimal strategy of weight management needs to consider both fat mass and dynamics of POPs. (shrink)

Halal means permissible or lawful in Arabic and is applied to both the religious and daily life of Muslims. Islamic Law Shariah requires Muslims to consume halal products only. But with the expansion of supply chains around the world and the development of many new products, Muslim consumers have found it difficult to confirm whether food is halal or not. Also, as many foods are produced in non-Muslim countries and exported to Muslim countries, interest in halal certification in non-Muslim countries (...) is increasing. With several Islamic countries strengthening their halal certification regulation for import in recent years, there is no accurate information on whether halal certification is necessary to export to Muslim countries or the Islamic State, and is lack of clear study of the definition of the Islamic State. Therefore, in this research, we will investigate the constitution and food import regulations of the Organization for Islamic Cooperation member states, called the Union of Islamic States, to study the definition of Islamic State and whether halal certification is necessary for food exports. (shrink)

The rapid development of machine-learning algorithms, which underpin contemporary artificial intelligence systems, has created new opportunities for the automation of work processes and management functions. While algorithmic management has been observed primarily within the platform-mediated gig economy, its transformative reach and consequences are also spreading to more standard work settings. Exploring algorithmic management as a sociotechnical concept, which reflects both technological infrastructures and organizational choices, we discuss how algorithmic management may influence existing power and social structures within organizations. We identify (...) three key issues. First, we explore how algorithmic management shapes pre-existing power dynamics between workers and managers. Second, we discuss how algorithmic management demands new roles and competencies while also fostering oppositional attitudes toward algorithms. Third, we explain how algorithmic management impacts knowledge and information exchange within an organization, unpacking the concept of opacity on both a technical and organizational level. We conclude by situating this piece in broader discussions on the future of work, accountability, and identifying future research steps. (shrink)

Learning to solve a class of problems can be characterized as a search through a space of hypotheses about the rules for solving these problems. A series of four experiments studied how different learning conditions affected the search among hypotheses about the solution rule for a simple computational problem. Experiment 1 showed that a problem property such as computational difficulty of the rules biased the search process and so affected learning. Experiment 2 examined the impact of examples as instructional tools (...) and found that their effectiveness was determined by whether they uniquely pointed to the correct rule. Experiment 3 compared verbal directions with examples and found that both could guide search. The final experiment tried to improve learning by using more explicit verbal directions or by adding scaffolding to the example. While both manipulations improved learning, learning still took the form of a search through a hypothesis space of possible rules. We describe a model that embodies two assumptions: the instruction can bias the rules participants hypothesize rather than directly be encoded into a rule; participants do not have memory for past wrong hypotheses and are likely to retry them. These assumptions are realized in a Markov model that fits all the data by estimating two sets of probabilities. First, the learning condition induced one set of Start probabilities of trying various rules. Second, should this first hypothesis prove wrong, the learning condition induced a second set of Choice probabilities of considering various rules. These findings broaden our understanding of effective instruction and provide implications for instructional design. (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)

This article has the purpose of examining the commentation that Sung-ho Yi Ik and Da-san Jung Yak-yong developed of Sa-chil Debate (사칠논쟁) Which was a philosophical debate in Chosun Dynasty. Sa-chil Debate began from Toe-gye Yi Whang and Ko-bong Gi Dae-sung and soon as a result of Yul-gok Yi Yi and Woo-gae Sung Hon repeating the debate, It appeared as a kind of philosophical theme. After that, Yul-gok and Toe-gye's students formed a kind of school. They also made the debate (...) extended and the theory more sophisticated by criticizing a counterpart's argument on base of ideologizing their teacher's theory. About 200 years after Toe-gye died, Sung-ho Yi Ik was born and after about 250 years, Da-san Jung Yak-yong was born. Both they experienced a western naturalscience and a catholic theory as Silhak Scholars (실학자). Therefore their this kind of interpretation about Sung-li Debate must be offering a deeply interesting investigation to us. In conclusion, Sung-ho advocated Toe-gye's theory at all, adding more explanation to it and Da-san evaluated all of Toe-gye's and Yul-gok's theory to be right because their theories have a unique logicality of making a sense. Sung-ho stood on a Shilhak view point gave up a organic cosmology ofSung-li theory which has a continuity to cosmology and moral theory, arguing Sa-chil-Li bal-Yil-lo Theory (四七理發一路說) by understanding Sa-chil Debate based on only moral perspective. Even though Da-san also said Yang-si Theory (兩是論) that both their theories are all right, he argued that Toe-gye's theory is much more important in the aspect of moral practice owing to his religious opinion by a catholic affect. By the way, Sung-ho supplemented and explained Toe-gye's theory, but he had not a sufficient logic and was not objective because of his leaning into advocating Toe-gye's theory much further. Da-san had an advantage of evaluating both Toe-gye's and Yul-gok's theory to be all right, but came to argue an insufficient philosophy on account of its simplicity. (shrink)

The purpose of this study is to examine whether corporate social responsibility activities perceived by consumers affect brand trust and corporate sustainability management. In other words, this study tried to examine whether the compatibility and authenticity of CSR influences brand trust, thereby affecting CSM including economic viability, environmental soundness, and social responsibility. To measure this, an empirical analysis was conducted on 479 consumers who had experience purchasing products from cosmetic companies that are carrying out CSR. As a result of the (...) analysis, it was found that the compatibility and authenticity of CSR have a positive effect on brand trust. Also, it was found that brand trust had a positive effect on social responsibility among the sub-concepts of CSM, but did not affect economic viability and environmental soundness. The results of this study are expected to provide strategic implications for social responsibility performance and brand trust building necessary for cosmetics companies to grow continuously. (shrink)

This paper is a short report about a series of picture books and manuals designed for P4C (especially Philosophy for Korean Young Children). There were not proper educational reading materials or books to help Korean young children to think by (or for) themselves and dialogue with. Dr. Sharp’s is a very helpful guidebook for young children to think by themselves, dialogue with friends, and discuss with others (peers, older or younger children, teacher and parents, etc.). However, there remain some needs (...) for consideration of Korean culture. I developed new eight picture books for young children and short manuals for parents and teachers to do ‘thinking experiments’ with children. The stories were created in the contexts of Korean young children’s daily lives and typical episodes. The community of inquiry, which Korean young children participate in, needs to consider general and special aspects, such as the relationship between peers, children-parents, and children-teachers, Confucius or new western customs, new and old generations, moral and cultural atmosphere of Korean kindergartens or childcare centers, etc. Various episodes and scenes in the picture books will revoke and encourage Korean children’s deeper or higher thinking, interesting and creative dialogues, vivid and harmonious discussions based on their own experiences and contexts of life in the community of inquiry. (shrink)

Background Conventional consent practices face ethical challenges in continuously evolving digital health environments due to their static, one-time nature. Dynamic consent offers a promising solution, providing adaptability and flexibility to address these ethical concerns. However, due to the immaturity of the concept and accompanying technology, dynamic consent has not yet been widely used in practice. This study aims to identify the facilitators of and barriers to adopting dynamic consent in real-world scenarios. Methods This scoping review, conducted in December 2022, adhered (...) to the PRISMA Extension for Scoping Reviews guidelines, focusing on dynamic consent within the health domain. A comprehensive search across Web of Science, PubMed, and Scopus yielded 22 selected articles based on predefined inclusion and exclusion criteria. Results The facilitators for the adoption of dynamic consent in digital health ecosystems were the provision of multiple consent modalities, personalized alternatives, continuous communication, and the dissemination of up-to-date information. Nevertheless, several barriers, such as consent fatigue, the digital divide, complexities in system implementation, and privacy and security concerns, needed to be addressed. This study also investigated current technological advancements and suggested considerations for further research aimed at resolving the remaining challenges surrounding dynamic consent. Conclusions Dynamic consent emerges as an ethically advantageous method for digital health ecosystems, driven by its adaptability and support for continuous, two-way communication between data subjects and consumers. Ethical implementation in real-world settings requires the development of a robust technical framework capable of accommodating the diverse needs of stakeholders, thereby ensuring ethical integrity and data privacy in the evolving digital health landscape. (shrink)

ObjectivePrevious research has shown that adolescents in single-mother households are at heightened risk for adjustment problems. However, limited studies have investigated the mechanisms leading to adolescent problem behaviors in single-mother households. To address this research gap, this study applied the Family Stress Model to examine how single mothers’ material hardship is linked to adolescent problem behaviors, focusing on the mediating roles of mothers’ depression and mother-adolescent closeness. The moderating role of adolescent school connectedness in the relationships between mother-adolescent closeness and (...) school connectedness and between mothers’ depression and school connectedness was also investigated.Materials and methodsThe study analyzed data from 1,384 adolescents and their single mothers who participated in the Fragile Families and Child Wellbeing Study at Wave 6. The associations between study variables were analyzed using structural equation modeling by decomposing the direct, indirect, and total effects of material hardship on adolescent problem behaviors. School connectedness’s interactions with mother-adolescent closeness and mothers’ depression were also examined.ResultsResults showed a significant indirect relationship between material hardship and adolescent problem behaviors through sequential mediation of mothers’ depression and mother-adolescent closeness. Mothers’ depression also significantly mediated the relationship between material hardship and problem behaviors. Lastly, school connectedness moderated the relationship between mother-adolescent closeness and adolescents’ internalizing behaviors. The association between mother-adolescent closeness and adolescents’ internalizing behavior was weaker for adolescents with higher levels of school connectedness.ConclusionThe results indicate the important indirect effect of economic strain on adolescents’ problems behaviors in single-mother households, which has been less emphasized compared to the effects in earlier childhood. High rates of material hardship and adolescent problem behaviors in single-mother families call for multifaceted interventions focusing on family processes and protective factors, including school environment. (shrink)