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

BackgroundBoosting the individual learning passion of medical students is a novel approach to improve their academic performance. It facilitates the medical education reform, motivating both policymakers and educators to focus on the function of positive psychology in the career development of medical students. Therefore, this study aimed to assess the status of two types of learning passion; to clarify the relationship between self-esteem and two types of learning passion among Chinese medical students; to examine the mediating role of psychological capital (...) in the relationship between self-esteem and two types of learning passion, respectively; and to identify the moderating role of professional identity in the relationship between PsyCap and two types of learning passion, respectively.MethodsA cross-sectional online survey was conducted from April to June 2016 in China. A total of 1,218 valid questionnaires were collected from four medical schools.ResultsSelf-esteem significantly and positively influenced medical students’ PsyCap.ConclusionTwo types of learning passion of medical students are positively influenced by self-esteem and PsyCap. Medical students with high-level self-esteem should possess strong PsyCap, which augments their harmonious as well as obsessive learning passion. Moreover, the positive effect of medical students’ PsyCap on harmonious learning passion is more notable among those with a lower professional identity. Finally, this study argues that strengths-based interventions of self-esteem and PsyCap are a beneficial approach for future enhancing learning passion in the domain of medical education. (shrink)

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

An interesting phenomenon called “hidden opportunity cost of time effect” was detected in intertemporal choices. The majority of our participants preferred the smaller but sooner (SS) option to the larger but later (LL) option if opportunity cost was explicit. However, a higher proportion of participants preferred the LL to SS option if opportunity cost was hidden. This shift violates the invariance principle and opens a new way to encourage future-oriented behavior. By simply mentioning the ‘obvious’ opportunity cost of alternatives, decision (...) makers can be more informed in prioritizing their long-term goals rather than short-term goals. (shrink)

Recent studies have found abnormal levels of brain-derived neurotrophic factor in a variety of central nervous system diseases. This suggests that BDNF may be involved in the pathogenesis of these diseases. Moreover, regulating BDNF signaling may represent a potential treatment for such diseases. With reference to recent research papers in related fields, this article reviews the production and regulation of BDNF in CNS and the role of BDNF signaling disorders in these diseases. A brief introduction of the clinical application status (...) of BDNF is also provided. (shrink)

This study aims to explore if local responsiveness pressure and subsidiary resources influence green management adoption of overseas subsidiaries, and to investigate the relationships between the level of green management adoption and performance. The 101 effective samples were collected from 583 Taiwanese firms, which are listed in the top 1000 manufactory firms and have invested in China. Though structural equation model analysis' empirical results indicate that local responsiveness pressure and subsidiary resources both have positive effects on the level of green (...) management adoption of the subsidiary. This study also suggests that the level of green management adoption is positively related to the subsidiary's performance. (shrink)

Literature on ethical behavior has paid little attention to the mechanism between macro-environmental variables and environmental performance. This study aims at constructing a model to examine the relationships which link cultural values, population growth, economic development, and environmental performance by incorporating the mediating role of education. The multiple linear regression model was employed to test the hypotheses on a 3-year-pooled sample of 51 countries. Empirical results conclude that national culture, economic development, and population growth would significantly influence environmental performance directly. (...) In addition, through the mediating effect of education, population growth and national culture would significantly affect environmental performance indirectly. These findings provide theoretical and managerial implications for constructing the mechanism of cultural values and ethical behavior in general and environmental management in particular. (shrink)

This study aims to explore if local responsiveness pressure and subsidiary resources influence green management adoption of overseas subsidiaries, and to investigate the relationships between the level of green management adoption and performance. The 101 effective samples were collected from 583 Taiwanese firms, which are listed in the top 1000 manufactory firms and have invested in China. Though structural equation model (SEM) analysis' empirical results indicate that local responsiveness pressure and subsidiary resources both have positive effects on the level of (...) green management adoption of the subsidiary. This study also suggests that the level of green management adoption is positively related to the subsidiary's performance. (shrink)

BackgroundNurses working in the intensive care unit clung tenaciously to their job during the COVID-19 pandemic in spite of enduring stressed psychological and physical effects as a result of providing nursing care for the infected patients, which indicates that they possessed a high degree of professionalism and career calling. The aim of this study was to explain the associations between resilience, thriving at work, and ethical leadership influencing the calling of ICU nurses.MethodsFrom December 2020 to January 2021 during the COVID-19 (...) pandemic, a cross-sectional survey of 15 provinces in China was conducted using an online questionnaire. A total of 340 ICU nurses completed sufficient responses to be used in the study. Sociodemographic factors, job demographic factors, resilience, calling, thriving at work, and ethical leadership were assessed using the questionnaire. General linear modeling, hierarchical linear regression analysis, and generalized additive model were performed to examine all the considered research hypotheses.ResultsResilience was positively and significantly associated with calling. Moreover, thriving at work partially mediated the relationship between resilience and calling. The indirect effect of resilience on calling was 0.204, and the direct effect of resilience on calling through thriving at work was 0.215. The total effect of resilience on calling was 0.419. In addition, ethical leadership played a moderating role in the relationship between resilience and calling.ConclusionGreater resilience can positively predict increased calling among Chinese ICU nurses during the COVID-19 pandemic. Moreover, thriving at work is a mechanism that partly transmits the positive effects of resilience on calling. Overall, nurses possessing greater resilience tend to maintain thriving at work in the face of such adversity, further resulting in subsequently increased calling. Besides, findings suggest that there is stronger influence of resilience on calling among nurses working in an organization managed by an ethical leader. The current findings may offer two insights for nursing practitioners and policymakers in the postpandemic world. First, resilience training and intervention are necessary to foster nurses' sense of thriving at work in the nursing industry, further promoting career calling. Second, better training and effort on the development of ethical leadership for leaders in nursing practice are essential to encourage followers to engage in social learning of ethical behaviors and abiding by normatively appropriate conduct, further enacting prosocial values and expressing moral emotions. (shrink)

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

The aim of this study was to compare the learning effectiveness of peer tutored problem-based learning and conventional teaching of nursing ethics in Taiwan. The study adopted an experimental design. The peer tutored problem-based learning method was applied to an experimental group and the conventional teaching method to a control group. The study sample consisted of 142 senior nursing students who were randomly assigned to the two groups. All the students were tested for their nursing ethical discrimination ability both before (...) and after the educational intervention. A learning satisfaction survey was also administered to both groups at the end of each course. After the intervention, both groups showed a significant increase in ethical discrimination ability. There was a statistically significant difference between the ethical discrimination scores of the two groups (P < 0.05), with the experimental group on average scoring higher than the control group. There were significant differences in satisfaction with self-motivated learning and critical thinking between the groups. Peer tutored problem-based learning and lecture-type conventional teaching were both effective for nursing ethics education, but problem-based learning was shown to be more effective. Peer tutored problem-based learning has the potential to enhance the efficacy of teaching nursing ethics in situations in which there are personnel and resource constraints. (shrink)

Recent advances in mobile electroencephalogram (EEG) systems, featuring non-prep dry electrodes and wireless telemetry, have urged the needs of mobile brain-computer interfaces (BCIs) for applications in our daily life. Since the brain may behave differently while people are actively situated in ecologically-valid environments versus highly-controlled laboratory environments, it remains unclear how well the current laboratory-oriented BCI demonstrations can be translated into operational BCIs for users with naturalistic movements. Understanding inherent links between natural human behaviors and brain activities is the key (...) to ensuring the applicability and stability of mobile BCIs. This study aims to assess the quality of steady-state visual-evoked potentials (SSVEPs), which is one of promising channels for functioning BCI systems, recorded using a mobile EEG system under challenging recording conditions, e.g., walking. To systemati-cally explore the effects of walking locomotion on the SSVEPs, this study instructed subjects to stand or walk on a treadmill running at speeds of 1, 2, and 3 mile (s) per hour (MPH) while con-currently perceiving visual flickers (11 and 12 Hz). Empirical results of this study showed that the SSVEP amplitude tended to deteriorate when subjects switched from standing to walking. Such SSVEP suppression could be attributed to the walking locomotion, leading to distinctly deteriorated SSVEP detectability from standing (84.87±13.55%) to walking (1 MPH: 83.03±13.24%, 2 MPH: 79.47±13.53%, and 3 MPH: 75.26±17.89%). These findings not only demonstrated the applicability and limitations of SSVEPs recorded from freely behaving humans in realistic environments, but also provide useful methods and techniques for boosting the translation of the BCI technology from laboratory demonstrations to practical applications. (shrink)

Through users’ cross-system comparative experience engaging with the health systems in Taiwan and other countries, this article probes into their understandings and value judgments and specifically their reasonings for the ‘solidarity with whom?’ question in the health sector solidarity. With the cross-system comparison approach, the study adopted semi-structured interviews with 30 Taiwanese participants who have studied, lived or worked abroad and engaged with the health system in Canada, the USA or the UK. This approach offers the opportunity for one to (...) evaluate the health system in the home country from a relative viewpoint from the host country. The participants suggested that the boundary of Taiwan’s National Health Insurance (NHI) should be as inclusive as possible, covering all legal residents in Taiwan regardless of their status, and that the citizens should share more financial responsibility. The ethical reasons for supporting the NHI include recognizing health sector solidarity among people, considering the coverage as a protection of the human right to health, humanitarian reasons and self-interest. Three archetypes of users emerged from the synthesis: Universalists, Rationalists and Republicans. The cross-system comparative experience makes the participants have more supportive attitudes toward the ideals of health sector solidarity. (shrink)

Two kinds of probability expressions, verbal and numerical, have been used to characterize the uncertainty that people face. However, the question of whether verbal and numerical probabilities are cognitively processed in a similar manner remains unresolved. From a levels-of-processing perspective, verbal and numerical probabilities may be processed differently during early sensory processing but similarly in later semantic-associated operations. This event-related potential (ERP) study investigated the neural processing of verbal and numerical probabilities in risky choices. The results showed that verbal probability (...) and numerical probability elicited different N1 amplitudes but that verbal and numerical probabilities elicited similar N2 and P3 waveforms in response to different levels of probability (high to low). These results were consistent with a level-of-processing framework and suggest some internal consistency between the cognitive processing of verbal and numerical probabilities in risky choices. Our findings shed light on possible mechanism underlying probability expression and may provide the neural evidence to support the translation of verbal to numerical probabilities (or vice versa). (shrink)

Mencius, a prominent Confucian philosopher in the Warring States period of ancient China, is well-known for his argumentative skills, including his refutational skills used to maintain his own standpoints. This paper attempts to reveal how Mencius refuted his opponents argumentatively and strategically on the issue of human nature. To this end, the pragma-dialectical approach to argumentation is adopted to first reconstruct Mencius’s argumentative discourse on human nature according to the four stages in critical discussion—the confrontation, opening, argumentation and concluding stages. (...) Under the ancient Chinese historical and cultural context, Mencius’s argumentative discourse about human nature was developed in three critical discussions, between Mencius the protagonist, and his explicit interlocutors and implicit adversaries who held different views on human nature—the antagonists. The discussions were undertaken around three single mixed differences of opinion concerning three propositions, with resolution of the first difference of opinion serving as a starting point of the second, and the resolution of the second as a starting point of the third. Then based on the reconstruction, the paper elaborates the refutational strategies that Mencius employed in various stages, such as dissociation, reductio ad absurdum based on refutational analogy, and conciliation. It further points out that the employment of these strategies is strategic maneuvering undertaken by Mencius in an attempt to realize both dialectical and rhetorical aims. (shrink)

Both glycemic control and handgrip strength affect microvascular function. Multiscale entropy of photoplethysmographic pulse amplitudes may differ by diabetes status and hand activity. Of a middle-to-old aged and right-handed cohort without clinical cardiovascular disease, we controlled age, sex, and weight to select the unaffected,the well-controlled diabetes, and the poorly controlled diabetes groups. MSEs were calculated from consecutive 1,500 PPG pulse amplitudes of bilateral index fingertips. Thesmall-, medium-,and large-scale MSEs were defined as the average of scale 1, scales 2–4, and scales (...) 5–10, respectively. Intra- and intergroups were compared by one- and two-samplet-tests, respectively. The dominant handMSE5–10was lower in the poorly controlled diabetes group than the well-controlled diabetes and the unaffected groups, whereas the nondominant handMSE5–10was lower in the well- and poorly controlled diabetes groups than the unaffected group. TheMSE1of dominant hand was higher than that of nondominant hand in the well-controlled diabetes. In conclusion, diabetes status and hand dominance may affect the MSE of PPG pulse amplitudes. (shrink)

This paper proposes a constrained solution update strategy for multiobjective evolutionary algorithm based on decomposition, in which each agent aims to optimize one decomposed subproblem. Different from the existing approaches that assign one solution to each agent, our approach allocates the closest solutions to each agent and thus the number of solutions in an agent may be zero and no less than one. Regarding the agent with no solution, it will be assigned one solution in priority, once offspring are generated (...) closest to its subproblem. To keep the same population size, the agent with the largest number of solutions will remove one solution showing the worst convergence. This improves diversity for one agent, while the convergence of other agents is not lowered. On the agent with no less than one solution, offspring assigned to this agent are only allowed to update its original solutions. Thus, the convergence of this agent is enhanced, while the diversity of other agents will not be affected. After a period of evolution, our approach may gradually reach a stable status for solution assignment; i.e., each agent is only assigned with one solution. When compared to six competitive multiobjective evolutionary algorithms with different population selection or update strategies, the experiments validated the advantages of our approach on tackling two sets of test problems. (shrink)

Intentional change when viewed as making a risky or intertemporal choice with evolutionary relevance helps us understand its successes and its failures. To promote future-oriented ecological rationality requires establishing a linkage between nongenetic, cultural, and symbolic selections and genetic adaptations. Coupled with biophilic instinct, intentional conservation is more likely to prevail against evolved desires of environmental exploitation.

BackgroundBreast cancer patients are at elevated risk of depression during treatment, thus provoking the chance of poor clinical outcomes. This retrospective cohort study aimed to investigate whether integrating Chinese herbal medicines citation into conventional cancer therapy could decrease the risk of depression in the long-term breast cancer survivors.MethodsA cohort of patients aged 20–70 years and with newly diagnosed breast cancer during 2000–2008 was identified from a nationwide claims database. In this study, we focused solely on survivors of breast cancer at (...) least1 year after diagnosis. After one-to-one matching for age, sex, and baseline comorbidities, breast cancer patients who received and did not receive CHM treatment were enrolled. The incidence rate and hazard ratio citation for depression between the two groups was estimated at the end of 2012. A Cox proportional hazard model was constructed to examine the impact of the CHM use on the risk of depression.ResultsDuring the study period, the incidence rate of depression was significantly lower in the treated cohort than in the untreated cohort [8.57 compared with 11.01 per 1,000 person-years citation], and the adjusted HR remained significant at 0.74 in a Cox proportional hazards regression model. The corresponding risk further decreasing to 43% among those using CHM for more than 1 year.ConclusionFinding from this investigation indicated that the lower risk of depression observed in breast cancer patients treated with CHM, suggesting that CHM treatment should be considered for disease management toward breast cancer. Yet, the optimal administered dose should be determined in further clinical trials. (shrink)

This study constructs a mechanism of the influence of Guanxi between boundary spanners on opportunistic behaviors in collaborative innovation projects based on the theory of reasoned action model. The study conducts a survey in the automobile industry in Changchun, Jilin Province, China, and analyzes the research data using the structural equation model. The findings show that Guanxi has a negative an significant influence on opportunistic behavior attitudes and subjective norms., Guanxi has the greater influence on subjective norms than attitudes. Then, (...) opportunistic behavior attitudes and subjective norms positively influence intentions. The influence of subjective norms is stronger. The attitudes and subjective norms of opportunistic behaviors also play mediation roles. Furthermore, opportunistic behavior intentions have a positive and significant influence on behaviors. In short, the study’s findings reveal a mechanism of Guanxi between boundary spanners influencing opportunistic behaviors of boundary spanners. It also provides a reference for corporate managers to govern opportunistic behaviors of collaborator while inhabiting opportunistic behaviors of their own boundary spanners. (shrink)

To understand the mechanism of boundary personnel opportunistic behaviors in collaborative R&D projects to reduce the risk of companies suffering from opportunism in collaboration. This study is conducted based on the context of collaborative R&D in the equipment manufacturing industry in Northeast China. This research mainly explored the mechanism of boundary personnel opportunistic intentions. Drawing on the theory of reasoned action, this study investigated the relationship between boundary personnel Guanxi, organizational loyalty, opportunistic attitudes, subjective norms, and intentions. In addition, this (...) research examined the moderating role of the degree of dependence on the collaborator. In total, 524 valid questionnaires were finally collected. The data analysis results suggested that Guanxi inhibits opportunistic attitudes and subjective norms. Organizational loyalty promotes opportunistic attitudes and subjective norms. Opportunistic attitudes and subjective norms positively predict intentions. Opportunistic attitudes mediate between organizational loyalty and opportunistic intentions. Opportunistic subjective norms mediate between Guanxi and opportunistic intentions. Opportunistic subjective norms also mediate between organizational loyalty and opportunistic intentions. Dependence on the collaborator positively moderates the relationship between opportunistic attitudes and intentions. Therefore, it can be argued that in collaborative R&D in the equipment manufacturing industry, the corporate could stimulate boundary personnel to build good Guanxi to eliminate opportunism. At the same time, companies should lead employees to show loyalty properly, which opportunism is not wise in collaborative R&D. Finally, enterprises should objectively understand and evaluate the dependence relationship between the two partners in collaborative R&D to adopt the right strategy. (shrink)

This study aims to identify research trends of scaffolding in the field of science education. To this end, both descriptive analysis and co-word analysis were conducted to examine the selected articles published in the Social Science Citation Index journals from 2000 to 2019. A total of 637 papers were retrieved as research samples through rounds of searching in Web of Science database. Overall, this study reveals a growing trend of science educators' academic publications about scaffolding in the recent two decades. (...) In these sample papers, from 1,487 non-repeated keywords, we extracted 286 author-defined keywords shared by at least two studies as a benchmark dictionary. A series of co-word analyses were then conducted based on the dictionary to reveal the underlying co-occurring relationships of the words in title and abstract of the sample papers. Results showed that “scaffolding,” “support,” and “design” were the top three most frequently used keywords during 2000 and 2019. Visualization of co-word networks in each 5-year period further helps clarify both educators' common research foci and relevant research trends. Derived discussion and potential research directions are also provided. (shrink)

The study of education systems as social phenomena has led scholars to question the role of education in modern society. The question of how to improve education naturally leads to concerns about what is wrong with the present education system. If education is meant to elevate the next generation, how can it meet the goal of ensuring a meaningful existence for those being educated? Scholars have demonstrated that education has been reduced to a process of the construction of objects, where (...) curriculum as techne commodifies students into products with market value. We propose that the tendency of interpreting techne as technology is a perspective of the modern age, and the rules of modern education are based on the rules of modern technology, under the guidance of the paradigm of productivity. We will introduce a broader interpretation of techne which frames it as the cultivation of virtue, i.e., virtue-techne. On this basis, education could be viewed as techne in the sense of praxis, rather than as fabrication in the sense of production. We highlight the rising rate of student suicides in Taiwan in recent years, where we determine the education system lacks a focus on praxis. This article investigates alternative praxis-oriented notions of education, from Aristotle's cultivation of virtue to Hadot's "spiritual exercises," to advocate for a shift away from the production paradigm. Indebted to Heidegger, we clarify his "techne as revealing" by emphasizing two frameworks for education: The first, modern education being valued by its adherence to metrics based in the paradigm of production. The second, education as a process wherein its value is derived from the life context of the participating individual. Finally, as a comparative study, we explore the current state of education in Russia and Taiwan, and present the case of one high school in Taiwan which has adopted the practice of spiritual exercises in its curriculum, including a required hike to the peak of Taiwan's tallest mountain, to cultivate a sense of the liberated life before its students graduate. (shrink)