Discussions of patient-centred care and patient autonomy in bioethics have tended to focus on the decision-making context and the process of obtaining informed consent, leaving open the question of how patients ought to be counselled in the daily maintenance of their health and management of chronic disease. Patient activation is an increasingly prominent counselling approach and measurement tool that aims to improve patients’ confidence and skills in managing their own health conditions. The strategy, which has received little conceptual or ethical (...) analysis, raises important questions about how clinicians ought to foster confidence and a sense of control in their patients without exposing them to blame, stigma and other harms. In this paper, we describe patient activation, discuss its relationship to personal responsibility, autonomy and health disparities, and make recommendations regarding its use and measurement. (shrink)

In two studies, 5- and 6-year-old children were questioned about the status of the protagonist embedded in three different types of stories. In realistic stories that only included ordinary events, all children, irrespective of family background and schooling, claimed that the protagonist was a real person. In religious stories that included ordinarily impossible events brought about by divine intervention, claims about the status of the protagonist varied sharply with exposure to religion. Children who went to church or were enrolled in (...) a parochial school, or both, judged the protagonist in religious stories to be a real person, whereas secular children with no such exposure to religion judged the protagonist in religious stories to be fictional. Children's upbringing was also related to their judgment about the protagonist in fantastical stories that included ordinarily impossible events whether brought about by magic or without reference to magic . Secular children were more likely than religious children to judge the protagonist in such fantastical stories to be fictional. The results suggest that exposure to religious ideas has a powerful impact on children's differentiation between reality and fiction, not just for religious stories but also for fantastical stories. (shrink)

Objectives: To quantify the use of do-not-resuscitate orders in a tertiary-care children’s hospital and to characterise the circumstances in which such orders are written.Design: Retrospective study conducted in a 500-bed children’s hospital in Taiwan.Patients: The course of 101 patients who died between January 2002 and December 2005 was reviewed. The following data were collected: age at death, gender, disease and its status, place of death and survival. There were 59 males and 42 females with a median age of 103 months (...) . 50 children had leukaemias, and 51 had malignancies other than leukaemia. The t test and the χ2 test were applied as appropriate.Results: The study found that 44% of patient deaths occurred in the paediatric oncology ward; 29% of patient deaths occurred in the intensive care unit; and 28% of patients died in their home or at another hospital. Other findings included the following: 46 of 101 patients died after attempted cardiopulmonary resuscitation and 55 died with a DNR order in effect. The mean age at death was 9.8 years in both groups with or without DNR orders.Conclusions: From the study of patient deaths in this tertiary-care children’s hospital, it was concluded that an explicit DNR order is now the rule rather than the exception, with more DNR orders being written for patients who have been ill longer, who have solid tumours, who are not in remission and who are in the ward. (shrink)

Among the studies on the perception of gaze vs. non-gaze stimuli, some have shown that the two types of stimuli trigger different patterns of attentional effects, while others have reported no such differences. In three experiments, we investigated the role of stimulus perceivability in spatial interference effects when the targets were gaze vs. non-gaze stimuli. We used a spatial Stroop task that required participants to make a speeded response to the direction indicated by the targets located on the left or (...) right side of fixation. In different experiments, the targets consisted of eyes, symbols, and/or arrows. The results showed that the magnitude of the spatial congruency effect differed between the types of targets when stimulus perceivability was not controlled. However, when the perceivability of the task relevant parts was comparable between the different types of targets, similar congruency effects were found regardless of target type. These results underscore the importance of controlling for stimulus perceivability, which is closely linked to the attentional zoom required to perform a task, when making inferences about the attentional mechanisms in the processing of gaze vs. non-gaze stimuli. (shrink)

Our thoughts, feelings, and behaviors are shaped in critical ways by our beliefs about how we compare to other people. Prior research has predominately focused on the consequences of believing oneself to be better than average (BTA). Research on the consequences of worse-than-average (WTA) beliefs has been far more limited, focusing mostly on the downsides of WTA beliefs. In this paper, we argue for the systematic investigation of the possible long-term benefits of WTA beliefs in domains including motivation, task performance, (...) and subjective well-being. We develop a conceptual framework for examining these possible benefits, we explore the usefulness of this framework to generate novel insights in an important psychological domain (skill learning), and we conclude with broader recommendations for research in other domains such as friendship formation, moral, and political decision making. (shrink)

This study investigated the differences between past and future temporal discounting in terms of neural activity in relation to temporal distance. Results show that brain regions are engaged differently in past and future temporal discounting. This is likely because past temporal discounting requires memory reconstruction, whereas future temporal discounting requires the processing of uncertainty about the future. In past temporal discounting, neural activity differed only when preferences were made between rewards received one hour prior and rewards received further in the (...) past. The peak amplitudes of P2 and P3 varied as the temporal distance increased from 2 weeks to 50 years. In future temporal discounting, neural activity differed only when preferences were evaluated between two delayed rewards. The delay conditions and had a significant influence on P2 and N2. Findings indicate the existence of different decision-making systems operating in past and future temporal discounting. (shrink)

Access to legal information is fundamental to access to justice. Yet accessibility refers not only to making legal documents available to the public, but also rendering legal information comprehensible to them. A vexing problem in bringing legal information to the public is how to turn formal legal documents such as legislation and judgments, which are often highly technical, to easily navigable and comprehensible knowledge to those without legal education. In this study, we formulate a three-step approach for bringing legal knowledge (...) to laypersons, tackling the issues of navigability and comprehensibility. First, we translate selected sections of the law into snippets (called CLIC-pages), each being a small piece of article that focuses on explaining certain technical legal concept in layperson’s terms. Second, we construct a Legal Question Bank, which is a collection of legal questions whose answers can be found in the CLIC-pages. Third, we design an interactive CLIC Recommender. Given a user’s verbal description of a legal situation that requires a legal solution, CRec interprets the user’s input and shortlists questions from the question bank that are most likely relevant to the given legal situation and recommends their corresponding CLIC pages where relevant legal knowledge can be found. In this paper we focus on the technical aspects of creating an LQB. We show how large-scale pre-trained language models, such as GPT-3, can be used to generate legal questions. We compare machine-generated questions against human-composed questions and find that MGQs are more scalable, cost-effective, and more diversified, while HCQs are more precise. We also show a prototype of CRec and illustrate through an example how our 3-step approach effectively brings relevant legal knowledge to the public. (shrink)

Life education, also known as life and death education, is an important subject in Taiwan with institutions offering degree programs and courses that focus on quality learning and implementation of life education. What is interesting from the perspective of Taiwanese Education is that the teaching of life education also incorporates a number of Eastern-derived and conceptualized tenets, for example, Buddhist teaching and the importance of spiritual wisdom. This premise contends then that life education in Taiwan, in general, is concerned with (...) the promotion, fulfillment, and cherishing of quality life experiences (e.g., personal contentment, happiness). One example of life education, which resonates with other spiritual beliefs and religious faiths (e.g., Hinduism), is related to spiritual cultivation and the enlightenment of life wisdom. Our own teaching of the subject, likewise, places emphasis on the goal of teaching students to seek meaningful understanding of and appreciation for three major, interrelated components of life education: life wisdom, life practice, and life care. Life education is a beneficial subject as its theoretical understanding may help individuals cope with pathologies and negative life experiences. One negative life experience, in this case, is the ultimate fate of humankind: death. Approaching death and/or the onset of grief is something that we all have to experience. How does one approach death? It is not easy feat and, of course, grief for a loved one is personal and some of us struggle with this. We contend that spiritual cultivation and enlightenment, arising from life education, may assist us with the coping of death (e.g., the possibility of transcendence beyond the realm of life). Forming the premise of the present article, we propose that a person’s ‘spiritual and enlightened self’, reflecting the convergence of three major aspects of life education (i.e., Philosophical reflection, Enrichment of personal well-being, and Spiritual cultivation), would result in the initiation and creation of a number of virtues and positive characteristics – for example: having a positive outlook in life, showing compassion, forgiveness, etc. These virtues and quality characteristics, from our philosophical reasoning, are equivalent to those qualities that positive psychology advocates for. (shrink)

The practice of respecting patients’ autonomy is rooted in the healthcare professionals’ empathy for patients’ situations, without which appropriate supports to the patients during the informed consent process may be remarkably moderated. The purpose of this study was to explore elective surgery patients’ experiences during their decision-making process. This research was conducted using a phenomenological approach, and the data analysis was guided by Colaizzi’s method. A total of 17 participants were recruited from a hospital in southern Taiwan. Two major themes (...) emerged from the analyses: (a) a voluntary yet necessary alternative—to undergo a surgery and (b) alternatives compelled by the unalterable decision—the surgery. It was concluded that unless healthcare professionals can empathize with the distressed situation of their patients who are facing elective surgery, the practice of informed consent may become merely a routine. Nurses can be the best advocates for patients and facilitators to enhance communication between patients and healthcare personnel. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:258 Feminist Studies 47, no. 2. © 2021 by Feminist Studies, Inc. Mei-Hua Chen and Hong-zen Wang Flexible Intimacies in the Global Intimate Economy: Evidence from Taiwan’s Cross-Border Marriages When Lin Ping was interviewed by the first author of this article at a detention center in the southern city of Tainan, Taiwan, in September 2006, she was forty-three. At that time, she had been married to a Taiwanese (...) man for five years and had successfully obtained a permit for employment at a factory, earning NT$27,000 a month for working ten hours a day. However, before having obtained the work permit, Lin managed to find jobs in informal sectors as a cleaner, a care worker, and a stall vendor’s helper, earning NT$15,000 a month. By the time of our interview, Lin had gone to work at a brothel because she could not put up with her husband anymore. Lin’s husband is twenty years older than she is and, as she described their relationship, the huge age gap makes communication between the couple difficult. They fought often and fiercely. During those fights, Lin’s husband would threaten to divorce her and to not renew her application for residency, which would result in her immediate deportation to China. This did happen once when Lin’s husband refused to renew her work permit. As a result, Lin overstayed her visa and lost her job at the factory. Being thus unemployed, Lin had to dip into her savings and risked going into debt. Her dire financial situation caused her anxiety. Losing the regular income provided by her factory job meant not only having nothing to live on but also being unable to send money back home to China. Given that her marriage failed to provide her the work permit she needed, Lin wanted to leave her husband Mei-Hua Chen and Hong-zen Wang 259 and “go out” for her own good. When asked what she thinks of the stigma attached to commercial sex, Lin replied, “I need to be able to feed myself first. But if you don’t have a work permit and a job, it [sex work] is the only way out. So, I thought I would do it.” She continued: “Once I had the money, I would be able to run a small business such as a noodle stall or selling steam dumplings.” Lin Ping’s stories serve to sketch out the interconnectedness between cross-border sex work and cross-border marriage. As her experiences show, cross-border sex work and marriage tend to overlap in certain spheres; however, they are more often than not conceptualized as two separate institutions. Both are grouped under already dichotomized migratory categories such as marriage migrants and economic migrants, real marriage and fake marriage, legal workers and workers without permits, and legal and illegal migrants, etc. Such dichotomization downplays the fact that many marriage migrants, like economic migrants, invest great economic interests in cross-border marriages; it also downplays the fact that migrant sex workers might also be involved in having intimate relationships with someone. Apart from the entanglement of monetary exchange and intimacy, cross-border marriage and cross-border sex work are also parts of a global intimate economy in which the Global North appropriates southern women’s reproductive and intimate labor. Seen in this light, it becomes urgent to theorize how women from the South manage to survive in the global intimate economy by shifting between cross-border marriage and cross-border sex work in the North. Admittedly, such a Global North-and-South framework fits awkwardly when it comes to understanding Taiwan’s situation because economic development is the sole barometer used to define the North and the South, and economically, Taiwan should be in the North camp. Politically, however, due to the majority of nations not recognizing its sovereignty, Taiwan is much more peripheral than most southern countries, let alone China. Therefore, compared to countries in Southeast Asia, Taiwan is economically North but politically South. This semi-peripheral position in the North-South framework, in our view, makes Taiwan a unique case to theorize the global intimate economy. As a tactic... (shrink)

Our computational studies of infant language learning estimate the inherent difficulty of Arbib's proposal. We show that body language provides a strikingly helpful scaffold for learning language that may be necessary but not sufficient, given the absence of sophisticated language in other species. The extraordinary language abilities of Homo sapiens must have evolved from other pressures, such as sexual selection.

Plato's Symposium consists of six speeches on Eros with the addition of Alcibiades' praise of Socrates. Of these speeches Socrates' speech is philosophically most important. It is true that the speech is given as a report of Diotima's view on Eros, but ‘she is a double of the Platonic Socrates’, and we take her view as the theory of Socrates in this dialogue.

BackgroundSocial support plays an important role for health outcomes. Support for those living with chronic conditions may be particularly important for their health, and even for their survival. The role of support for the survival of cancer patients after receiving an allogeneic hematopoietic cell transplant is understudied. To better understand the link between survival and support, as well as different sources and functions of support, we conducted two studies in alloHCT patients. First, we examined whether social support is related to (...) survival. Second, we examined who provides which support and which specific support-related functions and tasks are fulfilled by lay caregivers and healthcare professionals.MethodsIn Study 1, we conducted a retrospective chart review of alloHCT patients and registered availability of a dedicated lay caregiver and survival. In Study 2, we prospectively followed patients after alloHCT from the same hospital, partly overlapping from Study 1, who shared their experiences of support from lay caregivers and healthcare providers in semi-structured in-depth interviews 3 to 6 months after their first hospital discharge.ResultsPatients with a dedicated caregiver had a higher probability of surviving to 100 days than patients without a caregiver, OR = 2.84, p = 0.042. Study 2 demonstrated the importance of post-transplant support due to patients’ emotional needs and complex self-care regimen. The role of lay caregivers extended to many areas of patients’ daily lives, including support for attending doctor’s appointments, managing medications and financial tasks, physical distancing, and maintaining strict dietary requirements. Healthcare providers mainly fulfilled medical needs and provided informational support, while lay caregivers were the main source of emotional and practical support.ConclusionThe findings highlight the importance of studying support from lay caregivers as well as healthcare providers, to better understand how they work together to support patients’ adherence to recommended self-care and survival. (shrink)

The purpose of this study was to investigate how the subjective impression of English speech would change when pause duration at punctuation marks was varied. Two listening experiments were performed in which written English speech segments were rated on a variety of evaluation items by both native-English speakers and non-native speakers. The ratings were then subjected to factor analysis. In the first experiment, the pauses in three segments were made into the same durations, from 0.075 to 4.8 s. Participants rated (...) the segments on 23 evaluation items on a rating scale from 1 to 10. A varimax rotation after PCA led to two factors that were related to speech style. These two factors could be interpreted as representing speech naturalness and speech rate. Speech segments with a pause duration of 0.6 s received the highest naturalness evaluation, while perceived speech rate decreased as the physical pause duration increased, without any changes in utterance segments. In the second experiment, a full-factorial design of pause durations within and between sentences, i.e., for commas and for periods, was implemented in two speech segments. The original speech segments and speech segments without any pauses were also included as control conditions. From ratings on 12 evaluation items, similar to Experiment 1, two factors representing speech naturalness and speech rate were obtained. The results showed again that the perceived speech rate decreased with an increase only in pause duration. As for speech naturalness, the highest evaluations occurred when pause durations were 0.6 s within sentences, and either 0.6 or 1.2 s between sentences. This recommends fixing all pause durations to 0.6 s as a practical way to train non-native speakers to make their spoken English appear more natural. (shrink)

Clinical medicine is an inexact science. In situations of uncertainty, we often ask an experienced colleague for a second opinion. But what if one could effectively call upon the experience of thou...

The objective of this study is to investigate the effects of emotional labor on job performance and satisfaction, as well as to examine the mediating effect of sleep problems and the moderating effects of personality traits. A time-lagged study was conducted on 864 health professionals. Scales for emotional labor, sleep, personality traits, and job satisfaction were used and job performance data was obtained from records maintained by human resources. Structural equation modeling was performed to investigate the relations. Sleep problems only (...) partially mediated the relationship between surface acting and job satisfaction but completely mediated the relationship between surface acting and job performance. Several personality traits were shown to moderate the relationship between surface acting and sleep problems. The effects were stronger for people with low agreeableness and high neuroticism. The relationship between high levels of deep acting and low levels of sleep problems was more pronounced in individuals with low extraversion. Supervisors should be conscious of emotional labor in the work context and provide necessary deep acting training to facilitate emotional regulation. (shrink)

Two models are developed for updating opinions in social networks under situations where certain beliefs might be considered to be competing. These two models represent different attitudes of people towards the perceived conflict between beliefs. In both models agents have a degree of tolerance, which represents the extent to which the agent takes into account the differing beliefs of other agents, and a degree of conflict, which represents the extent to which two beliefs are considered to be competing. Computer simulations (...) are used to determine how the opinion dynamics are affected by the inclusion of conflict. Results show that conflict can enhance the formation of consensus within the network in certain circumstances according to one of the models. (shrink)

Two models are developed for updating opinions in social networks under situations where certain beliefs might be considered to be competing. These two models represent different attitudes of people towards the perceived conflict between beliefs. In both models agents have a degree of tolerance, which represents the extent to which the agent takes into account the differing beliefs of other agents, and a degree of conflict, which represents the extent to which two beliefs are considered to be competing. Computer simulations (...) are used to determine how the opinion dynamics are affected by the inclusion of conflict. Results show that conflict can enhance the formation of consensus within the network in certain circumstances according to one of the models. (shrink)