우리 사회는 전례 없는 고령화 시대에 접어들었다. 지속적으로 진행되는 노화는 여러 가지 부정적인 감정을 동반한다. 우리가 살아가는 인생의 각 시기는 누구나 자신에게는 처음의 시간이다. 나이가 든다고 저절로 지혜로워지는 것은 아니다. 나이가 들면 우리는 삶의 가장 본질적인 부분을 다루는 철학에 관심을 갖게 마련이다. 반면 우리 사회에서 노년기에 대한 논의는 복지 분야에 집중되어 있기에 보다 풍성한 철학적 담론이 요청된다. 본 논문은 노년이 삶을 예술작품으로 조형함으로써 자존감을 회복하는 길을 모색하고자 한다. 리쾨르에 따르면 자기존중은 곧 자기해석이다. 자존감은 자기가 해석할 수 있는 능력을 가졌으며 선한 (...) 삶을 목표로 심사숙고한 선택을 따를 줄 아는 존재라는 것을 인정할 때 얻어진다. 이는 자신이 선한 삶을 추구하며 살아가는 윤리적 주체임을 증명하는 일이다. 자기존중은 타자를 배려해야 얻을 수 있기에 타자로 말미암아 만들어지는 자기해석이다. 자기해석과 실천이 따를 때 연륜은 성숙과 확장의 능동적인 과정이 되어 예술로서의 삶을 조형하게 될 것이다. 노년은 많은 사회적 관계들보다는 진정성이 있는 소수의 관계에 집중해야 할 때이다. 친애에 대한 해석학적 고찰은 노년담론에서 시사하는 바가 크다. 본고는 리쾨르의 자기성 형성에 있어서 자기존중과 타자배려의 과정에서 드러나는 조화와 새로움의 생성, 신뢰를 지키는 일관성의 맥락이 실존미학으로 귀결될 수 있음을 증명함으로써 노년에게 예술로서의 삶을 제시하고자 한다. (shrink)

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

Although any typology of constructivism might be arbitrary, there are, broadly speaking, two distinctive constructivist approaches in security studies as well as International Relations (IR) according to their different meta-theoretical stances: conventional constructivism, on the one hand, and critical constructivism on the other. Indeed, regarding how to understand state identity which is integral to national security, there has meta-theoretically been fierce contention between conventional and critical constructivist security studies. In not ignoring but slightly toning down this contention operating at the (...) abstract level, this article aims to present a pragmatic application of the two different (or conflicting) constructivisms to capturing a more complete picture of state identity formation in substantive empirical research of constructivist security studies. The pragmatic approach is that, without being immersed heavily in the meta-theoretical strife between the two seemingly conflicting constructivist camps, both constructivisms should be treated as different analytical frameworks for examining different (internal and external) faces of state identity formation: the external construction of state identity can be well addressed by conventional constructivism, while the internal one by critical constructivism. In this sense, the relationship between conventional and critical constructivism can be understood as not conflicting but complementary in empirical research, as both constructivisms enrich and deepen our understanding of state identity formation in different ways. (shrink)

Acknowledging separable factors underlying negative symptoms may lead to better understanding and treatment of negative symptoms in individuals with schizophrenia. The current study aimed to test whether the negative symptoms factor (NSF) of the Positive and Negative Syndrome Scale (PANSS) would be better represented by expressive and experiential deficit factors, rather than by a single factor model, using confirmatory factor analysis (CFA). Two hundred and twenty individuals with schizophrenia spectrum disorders completed the PANSS; subsamples additionally completed the Brief Negative Symptom (...) Scale (BNSS) and the Motivation and Pleasure Scale—Self-Report (MAP-SR). CFA results indicated that the two-factor model fit the data better than the one-factor model; however, latent variables were closely correlated. The two-factor model’s fit was significantly improved by accounting for correlated residuals between N2 (emotional withdrawal) and N6 (lack of spontaneity and flow of conversation), and between N4 (passive social withdrawal) and G16 (active social avoidance), possibly reflecting common method variance. The two NSF factors exhibited differential patterns of correlation with subdomains of the BNSS and MAP-SR. These results suggest that the PANSS NSF would be better represented by a two-factor model than by a single-factor one, and support the two-factor model’s adequate criterion-related validity. Common method variance among several items may be a potential source of measurement error under a two-factor model of the PANSS NSF. (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)

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)

As the COVID-19 pandemic continues to disrupt our lives in unimagined ways, families are reinventing daily rituals, and this is likely true for musical rituals. This study explored how parents with young children used recorded music in their everyday lives during the pandemic. Mothers of child aged 18 months to 5 years living in the United States played the role of home DJ over a period of one week by strategically crafting the sonic home environment, based on resources provided (...) by the authors, in response to their children’s mood and state. Using a newly developed data collection tool, inspired by the Experience Sampling Method, a total of 197 episodes were collected about children’s engagement with recorded music. Findings showed that while mothers utilized music to fulfill various emotional needs, they tended to use it to maintain or reinforce their child’s positive mood rather than to improve a negative mood. Also, mothers’ reports suggested various ways that young children engaged with music, being aligned with the multimodal nature of their musical experiences. Lastly, mothers reported that their strategic approaches to use recorded music seemed to help their children feel less distressed and happier, and this, in turn, aided in the reduction of some of the burdens associated with parenting. (shrink)

Muscle synergy analysis via surface electromyography is useful to study muscle coordination in motor learning, clinical diagnosis, and neurorehabilitation. However, current methods to extract muscle synergies in the upper limb suffer from two major issues. First, the necessary normalization of EMG signals is performed via maximum voluntary contraction, which requires maximal isometric force production in each muscle. However, some individuals with motor impairments have difficulties producing maximal effort in the MVC task. In addition, the MVC is known to be highly (...) unreliable, with widely different forces produced in repeated measures. Second, synergy extraction in the upper limb is typically performed with a multidirection reaching task. However, some participants with motor impairments cannot perform this task because it requires precise motor control. In this study, we proposed a new isometric rotating task that does not require precise motor control or large forces. In this task, participants maintain a cursor controlled by the arm end-point force on a target that rotates at a constant angular velocity at a designated force level. To relax constraints on motor control precision, the target is widened and blurred. To obtain a reference EMG value for normalization without requiring maximal effort, we estimated a linear relationship between joint torques and muscle activations. We assessed the reliability of joint torque normalization and synergy extraction in the rotating task in young neurotypical individuals. Compared with normalization with MVC, joint torque normalization allowed reliable EMG normalization at low force levels. In addition, the extraction of synergies was as reliable and more stable than with the multidirection reaching task. The proposed rotating task can, therefore, be used in future motor learning, clinical diagnosis, and neurorehabilitation studies. (shrink)

The vestibulo-ocular reflex plays an important role in controlling the gaze at a visual target. Although patients with vestibular hypofunction aim to improve their VOR function, some retain dysfunction for a long time. Previous studies have explored the effects of direct current stimulation on vestibular function; however, the effects of random noise stimulation on eye–head coordination have not previously been tested. Therefore, we aimed to clarify the effects of high frequency noisy vestibular stimulation on eye–head coordination related to VOR function. (...) Thirteen healthy young adult participants with no serious disease took part in our study. The current amplitude and density used were 0.4 mA and 0.2 mA/cm2, respectively, with a random noise frequency of 100–640 Hz. The electrodes were located on both mastoid processes. The stimulus duration and fade in/out duration were 600 and 10 s, respectively. Subjects oscillated their head horizontally, gazing at the fixation point, at 1 Hz for 30 repetitions. The coordination of eye–head movements was measured by eye-tracking and a motion capture system. Peak-to-peak angles for eye and head movement and deviation of the visual line from the fixation target revealed no significant differences between HF-nVS and sham. The lag time between the eye and head movement with HF-nVS post-stimulation was significantly shorter than that of the sham. We found that HF-nVS can reduce the lag time between eye and head movement and improve coordination, contributing to a clear retinal image. This technique could be applied as a form of VOR training for patients with vestibular hypofunction. (shrink)

Background and ObjectivesBecause of high skin cancer risks for young women, it is vital that effective interventions reach and influence this demographic. Visual social media platforms, like Instagram, are popular with young women and are an appropriate intervention site; yet, they also host competing images idealizing tan skin. The present study tested the ability of digital sun-safety interventions to affect self-control-related emotions and visual attention to subsequent tan-ideal images as well as sun-safety attitudes.MethodsWomen were recruited from a large (...) public Mid-Atlantic university in the United States. Participants were randomly assigned to view an appearance benefits intervention, a self-control emotions intervention, or a control message, each designed to look like an Instagram sponsored story. After self-reporting self-compassion and anticipated pride, participants then viewed seven pairs of Instagram posts featuring either tan or pale women while an eye tracker assessed visual attention. Finally, participants self-reported their responses to questions assessing sun-safety-related norms, efficacy, and attitudes.ResultsA mixed design analysis of covariance revealed that women who first viewed the appearance benefits intervention story spent less time visually fixated on Instagram images of tan women than did those who viewed the self-control emotions intervention or control message. Regressions also revealed interactions between the intervention conditions and feelings of anticipated pride on both visual attention and sun-safety attitudes.ConclusionSponsored stories on Instagram can promote sun-safety attitudes, depending on the emotional responses they generate. Additionally, sponsored interventions can affect subsequent visual attention. (shrink)

Biologically, pain is neither intrinsically good nor bad, but is a communication mechanism designed to serve organismal ends. Pain for any given person at any given time should be evaluated on the basis of “success” (or not) in serving those purposes. Yet, the physiological, psychological, and cultural complexity of the experience makes moral consideration of pain complicated. This is especially the case with infants in pain. The competence of the infant as a “decision maker” cannot, of course, be assumed. Even (...) if the child “thinks” about pain, an epistemological barrier exists in that the child cannot clearly communicate about the pain experience. Furthermore, any expressions of pain from the child may be necessary for diagnosis. Just coercion criteria provide a means of evaluating when and to what extent pain in infants should be controlled under the authority of surrogate decision makers. (shrink)

Although a common clinical phenomenon, delusions are difficult to explain and have a problematic conceptual status. Advances in understanding delusions have come from studies which involve detailed investigation of particular types of delusion. Some of this work is summarised, with the Capgras and Cotard delusions as specific examples. These are used to high-highlight questions for which there is the potential for fruitful dialogue with philosophers. Such questions include the criteria for deciding that a statement represents a belief, the extent to (...) which we integrate our beliefs into a coherent web, and the nature and limits of human rationality. (shrink)

With the growth of precision medicine research on health data and biospecimens, research institutions will need to build and maintain long-term, trusting relationships with patient-participants. While trust is important for all research relationships, the longitudinal nature of precision medicine research raises particular challenges for facilitating trust when the specifics of future studies are unknown. Based on focus groups with racially and ethnically diverse patients, we describe several factors that influence patient trust and potential institutional approaches to building trustworthiness. Drawing on (...) these findings, we suggest several considerations for research institutions seeking to cultivate long-term, trusting relationships with patients: Address the role of history and experience on trust, engage concerns about potential group harm, address cultural values and communication barriers, and integrate patient values and expectations into oversight and governance structures. (shrink)

The increasing complexity of human subjects research and its oversight has prompted researchers, as well as institutional review boards, to have a forum in which to discuss challenging or novel ethical issues not fully addressed by regulations. Research ethics consultation services provide such a forum. In this article, we rely on the experiences of a national Research Ethics Consultation Collaborative that collected more than 350 research ethics consultations in a repository and published 18 challenging cases with accompanying ethical commentaries to (...) highlight four contexts in which REC can be a valuable resource. REC assists: 1) investigators before and after the regulatory review; 2) investigators, IRBs, and other research administrators facing challenging and novel ethical issues; 3) IRBs and investigators with the increasing challenges of informed consent and risk/benefit analysis; and 4) in providing flexible and collaborative assistance to overcome study hurdles, mediate conflicts within a team, or directly engage with research participants. Institutions that have established, or plan to establish, REC services should work to raise the visibility of their service and engage in open communication with existing clinical ethics consult services as well as the IRB. While the IRB system remains the foundation for the ethical review of research, REC can be a valuable service for investigators, regulators, and research participants aligned with the goal of supporting ethical research. (shrink)

For years a debate has raged within the various literatures of philosophy, psychiatry, and psychology over whether, and to what degree, the concepts that characterize psychopathology are social constructions that reflect cultural values. While the majority position among philosophers has been normativist, i.e., that the conception of a mental disorder is value-laden, a vocal and cogent minority have argued that psychopathology results from malfunctions that can be described by terminology that is objective and scientific. Scientists and clinicians have tended to (...) endorse the objectivist position, with some notable exceptions. (shrink)

In their forthcoming article, ‘What makes a medical intervention invasive?’ De Marco, Simons, and colleagues explore the meaning and usage of the term ‘invasive’ in medical contexts. They describe a ‘Standard Account’, drawn from dictionary definitions, which defines invasiveness as ‘incision of the skin or insertion of an object into the body’. They then highlight cases wherein invasiveness is employed in a manner that is inconsistent with this account (eg, in describing psychotherapy) to argue that the term invasiveness is often (...) used to explicitly or implicitly reference interventions that do not fall under the standard account. The authors offer an alternative ‘schematic’ definition of invasiveness, whereby medical interventions entail an underlying context-independent property of ‘basic invasiveness’ and may be understood both relative to each other and to a context-specific threshold of what is ‘invasive’.1 We propose that the meaning of terms such as ‘invasiveness’ is necessarily heterogeneous, and that what is implied by its usage will certainly depend on context, particularly in medical settings. Hence, the creation of a unifying definition is less critical than clarification of the implied and intended meanings of each instance of the term’s use. We further argue that interpreting the use of terms like ‘invasiveness’ in medical practice is complicated by the embedding of each use of this term in a different ‘language game’, whereby words and their meanings are understood by an in-group familiar with …. (shrink)