Although the same environmental regulations apply to all regions in China, legal enforcement can be different due to local economic development priorities. There is still a lack of knowledge about how regional disparities affect the operating performance results of the implementation of corporate environmental management practices, thus providing little information for foreign companies when they invest and develop their production base in China. To fill this research gap, this paper collects data from the Fortune 500 Chinese firms to investigate the (...) moderating role of regional disparities in affecting the performance results of corporate environmental management efforts based on the institutional theory. The disclosed corporate environmental responsibility practices serve as proxy to represent corporate environmental management practices. Content analysis approach was applied to collect and analyze CER practices published in the corporate reports of Chinese manufacturers. The results show that CER has a positive impact on operating income, while regional disparities influence the relationship between CER and corporate operating income. Specifically, CER and operating income are positively related in Eastern China; on the contrary, they are negatively related in Western China. This paper adds to the body of knowledge about environmental discrepancies in the same emerging economy, and provides insights for systematic consideration in terms of the issues of government environmental regulations and corporate environmental strategies. (shrink)

Drawing on the behavioral theory, this study examines how the misalignment between a firm's environmental effort and the level of subsidies received from the government in affecting the firm's investment in non-environmental R&D. Based on a sample of Chinese A-share listed firms from 2008 to 2019 and using polynomial regression techniques, our findings reveal that firms in the “low effort-high subsidies” group exhibit lower non-environmental R&D intensity compared to firms in the “high effort-low subsidies” group. This study contributes to the (...) literature by shedding light on the interplay between corporate environmental efforts, government subsidies, and non-environmental R&D investment. The findings suggest the importance of aligning the environmental efforts of firms with subsidy levels from the government to effectively allocate resources for different types of R&D. The implications of this research suggest that firms should carefully consider aligning their environmental efforts with government subsidies to optimize their investment in non-environmental R&D and overall innovation strategy. Furthermore, the study indicates that firms and governments should prudently balance the relationship between environmental R&D and non-environmental R&D to avoid any negative impact on the latter. (shrink)

Background: Ethical nursing practice is increasingly challenging, and strategies for addressing ethical dilemmas are needed to support nurses’ ethical care provision. Conscientious objection is one such strategy for addressing nurses’ personal, ethical conflicts, at times associated with conscience. Exploring both conscience and conscientious objection provides understanding regarding their implications for ethical nursing practice, research, and education. Research aim: To analyze the concepts of conscience and conscientious objection in the context of nurses. Design: Concept analysis using the method by Walker and (...) Avant. Research context: Data were retrieved from Philosopher’s Index, PubMed, and CINAHL with no date restrictions. Ethical consideration: This analysis was carried out per established, scientific guidelines. Findings: Ethical concepts are integral to nursing ethics, yet little is known about conscientious objection in relation to conscience for nurses. Of note, both concepts are well established in ethics literature, addressed in various nursing codes of ethics and regulatory bodies, but the meaning they hold for nurses and the impact they have on nursing education and practice remain unclear. Discussion and conclusion: This article discusses the relevance of conscience and conscientious objection to ethical nursing practice and proposes a model case to show how they can be appreciated in the context of nurses. Conscientious objection is an option for ethical transparency for nurses but is situated in contentious discussions over its use and has yet to be fully understood for nursing practice. Conscience is an element in need of more exploration in the context of conscientious objection. Further research is warranted to understand how nurses respond to conscience concerns in morally, pluralistic nursing contexts. (shrink)

Background: While conscientious objection is a well-known phenomenon in normative and bioethical literature, there is a lack of evidence to support an understanding of what it is like for nurses to make a conscientious objection in clinical practice including the meaning this holds for them and the nursing profession. Research question: The question guiding this research was: what is the lived experience of conscientious objection for Registered Nurses in Ontario? Research design: Interpretive phenomenological methodology was used to gain an in-depth (...) understanding of what it means to be a nurse making a conscientious objection. Purposive sampling with in-depth interview methods was used to collect and then analyze data through an iterative process. Participants and research context: Eight nurse participants were interviewed from across practice settings in Ontario, Canada. Each participant was interviewed twice over 9 months. Ethical considerations: This study was conducted in accordance with Health Science Research Ethics Board approval and all participants gave consent. Findings: Six themes emerged from data analysis: encountering the problem, knowing oneself, taking a stand, alone and uncertain, caring for others, and perceptions of support. Discussion: This study offers an initial understanding of what it is like to be a nurse making a conscientious objection in clinical practice. Implications for nursing practice, education, policy, and further research are discussed. Conclusion: Addressing ethical issues in nursing practice is complex. The need for education across nursing, healthcare disciplines and socio-political sectors is essential to respond to nurses’ ethical concerns giving rise to objections. Conscience emerged as an informant to nurses’ conscientious objections. The need for morally inclusive environments and addressing challenging ethical questions as well as the concept of conscience are relevant to advancing nursing ethics and ethical nursing practice. (shrink)

Objectives: To study the attitudes of both medical and non-medical students towards the do-not-resuscitate decision in a university in Hong Kong, and the factors affecting their attitudes.Methods: A questionnaire-based survey conducted in the campus of a university in Hong Kong. Preferences and priorities of participants on cardiopulmonary resuscitation in various situations and case scenarios, experience of death and dying, prior knowledge of DNR and basic demographic data were evaluated.Results: A total of 766 students participated in the study. There were statistically (...) significant differences in their DNR decisions in various situations between medical and non-medical students, clinical and preclinical students, and between students who had previously experienced death and dying and those who had not. A prior knowledge of DNR significantly affected DNR decision, although 66.4% of non-medical students and 18.7% of medical students had never heard of DNR. 74% of participants from both medical and non-medical fields considered the patient’s own wish as the most important factor that the healthcare team should consider when making DNR decisions. Family wishes might not be decisive on the choice of DNR.Conclusions: Students in medical and non-medical fields held different views on DNR. A majority of participants considered the patient’s own wish as most important in DNR decisions. Family wishes were considered less important than the patient’s own wishes. (shrink)

Hand function improvement in stroke survivors in the chronic stage usually plateaus by 6 months. Brain-computer interface (BCI)-guided robot-assisted training has been shown to be effective for facilitating upper-limb motor function recovery in chronic stroke. However, the underlying neuroplasticity change is not well understood. This study aimed to investigate the whole-brain neuroplasticity changes after 20-session BCI-guided robot hand training, and whether the changes could be maintained at the 6-month follow-up. Therefore, the clinical improvement and the neurological changes before, immediately after, (...) and 6 months after training were explored in 14 chronic stroke subjects. The upper-limb motor function was assessed by Action Research Arm Test (ARAT) and Fugl-Meyer Assessment for Upper-Limb (FMA), and the neurological changes were assessed using resting-state functional magnetic resonance imaging. Repeated-measure ANOVAs indicated that long-term motor improvement was found by both FMA (F[2,26]= 6.367,p= 0.006) and ARAT (F[2,26]= 7.230,p= 0.003). Seed-based functional connectivity analysis exhibited that significantly modulated FC was observed between ipsilesional motor regions (primary motor cortex and supplementary motor area) and contralesional areas (supplementary motor area, premotor cortex, and superior parietal lobule), and the effects were sustained after 6 months. The fALFF analysis showed that local neuronal activities significantly increased in central, frontal and parietal regions, and the effects were also sustained after 6 months. Consistent results in FC and fALFF analyses demonstrated the increase of neural activities in sensorimotor and fronto-parietal regions, which were highly involved in the BCI-guided training.Clinical Trial Registration:This study has been registered atClinicalTrials.govwith clinical trial registration number NCT02323061. (shrink)

This article contends that environmental organisations vary in type, scale and purpose in ways that help stewards self-sort into the opportunities that align with their individual motivations and environmental concerns. To explore these potential links between personal motivations and environmental organisational attributes, we rely on descriptive and inferential statistics from surveys of two partner environmental organisations: one local scale community based-organisation and one a broader scale environmental non-profit organisation, both located in Central Texas, USA. These partners were selected based on (...) their compatible pro-environmental missions but disparate spatial scales of operation. The survey results (n=377) revealed meaningful between-organisation differences in volunteer environmental stewards, which raise the possibility of a ‘First Law of Environmental Stewardship’ whereby all stewards are related (by their values), but stewards in the same organisation are more related than stewards in different organisations. These findings expose some of the nuances of environmental volunteerism by highlighting connections between personal motivations, geographic scale, and organisation type. (shrink)

Much philosophical progress has been made in elucidating the idea of evolutionary contingency in a recent re-burgeoning of the debate. However, additional progress has been impaired on three fronts. The first relates to its characterisation: the under-specification of various contingency claims has made it difficult to conceptually pinpoint the scope to which ‘contingency’ allegedly extends, as well as which biological forms are in contention. That is—there appears to be no systematic means with which to fully specify contingency claims which has (...) led to a tendency for authors to talk past each other. Secondly, on the matter of evidence, recent research has focused on the evidential import of convergent evolution which is taken to disconfirm the evolutionary contingency thesis. However, there has been a neglect of convergent evolution’s converse: ‘evolutionary idiosyncrasies’ or the singular evolution of certain forms, which I argue is evidentially supportive of evolutionary contingency. Thirdly, evolutionary contingency has often been claimed to vary in degrees and that the debate, itself, is a matter of ‘relative significance’. However, there has been no formal method of evaluating the strength of contingency and its relative significance in a particular domain. In this paper, I address all three issues by proposing a systematic means of fully specifying contingency theses with the concept of the modal range. Secondly, I propose an account of evolutionary idiosyncrasies, investigate the explanations for their occurrences, and, subsequently, spell out their significance with respect to the evolutionary contingency thesis. Finally, having been equipped with the evidential counterpart to convergent evolution, I shall sketch a likelihood framework for evaluating, precisely on the basis of a sequence of opposing data, the strength and relative significance of evolutionary contingency in a particular domain. With this in hand, the relative observations of idiosyncrasies and convergences can be informative of the strength and relative significance of contingency in any particular domain. (shrink)

Explaining how stereotypes and norms influence role-identities during reflected appraisal processes, we develop a theory about diverse groups of minority men—the “minority masculinity stress theory”—and apply it to Asian American men. We conceptually integrate hegemonic masculinity, stereotypes, and mental health to examine how Asian American men experience masculinity and how their experiences are uniquely stressful. We analyze elicited text from an open-ended questionnaire to explain two experiences of masculinity-related stress: trying to live up to the masculine ideal and enacting work-related (...) role-identities. Regarding the former, we discuss four illustrations—toughness, body image, restrictive emotionality, and heterosexuality—and two involving the latter—achiever and provider. We found that Asian American men receive stereotypical reflected appraisals that contradict potentially positive self-concepts and emphasize achievement beyond typical standards of hegemonic masculinity. Moreover, Asian American men’s role-identities contradict hegemonic masculinity, resulting in reflected appraisals that predispose them toward stress. (shrink)

The practice of covertly administering medication is controversial. Although condemned by some as overly paternalistic, others have suggested that it may be acceptable if patients have permanent mental incapacity and refuse needed treatment. Ethical, legal, and clinical considerations become more complex when the mental incapacity is temporary and when the medication actually serves to restore autonomy. We discuss these issues in the context of a young man with schizophrenia. His mother had been giving him antipsychotic medication covertly in his soup. (...) Should the doctor continue to provide a prescription, thus allowing this to continue? We discuss this case based on the “four principles” ethical framework, addressing the conflict between autonomy and beneficence/non-maleficence, the role of antipsychotics as an autonomy restoring agent, truth telling and the balance between individual versus family autonomy. (shrink)

The Gouldian argument for evolutionary contingency found in Wonderful Life can be dissected into three premises: palaeontological, macro-evolutionary, and developmental. Discussions of evolutionary contingency have revolved primarily around the developmental. However, a shift in methodological practice and new palaeontological evidence subsequent to the book’s publication appears to threaten the palaeontological premise that asserts high Cambrian disparity, or, roughly, that morphological differences between the Cambrian species were high. This presents a prima facie problem: Did the Cambrian consist of enough anatomical variety (...) to fuel a different outcome upon a replay of the tape of life? I investigate the role that disparity plays in the Gouldian argument for evolutionary contingency and conclude that the reduced disparity view does not undermine the argument, per se. As for the macro-evolutionary premise, Gould never offers any explicit justification for the idea that species sorting was indiscriminate or ‘lottery-like’ (though he certainly gestures at it). Putting aside the exegetical, I consider certain empirical avenues for underwriting the macro-evolutionary premise and argue that the most plausible route is to appeal to the special status of mass extinctions, a move that is not entirely unfamiliar to macro-evolutionists. That is, mass extinctions can be good sources of contingency due to their being ‘chancy’ in at least three respects. In sum, I update the palaeontological and macro-evolutionary premises as to reconstrue the Gouldian argument for evolutionary contingency in its strongest form. (shrink)

I argue that the contextualist anti-skeptical strategy fails because it misconstrues skepticism by overlooking two important aspects of skepticism: first, all of our knowledge of the external world is brought into question at one fell swoop; second, skepticism depends on certain ideas about sense-perception and its role in our knowledge of the world. Contextualists may have solved ‘the skeptical paradox’ in their own terms, but such a solution cannot in any way make skepticism less threatening to human knowledge or to (...) the philosophical understanding of human knowledge. I also discuss some important aspects of the practice of knowledge attribution in order to show that the more we can make sense of particular knowledge attributions, the less we can take skepticism seriously, and that the practice of knowledge attribution as we understand and engage in it presupposes that we have knowledge of the world. (shrink)

Contingency-theorists have gestured to a series of phenomena such as random mutations or rare Armageddon-like events as that which accounts for evolutionary contingency. These phenomena constitute a class, which may be aptly called the ‘sources of contingency’. In this paper, I offer a probabilistic conception of what it is to be a source of contingency and then examine two major candidates: chance variation and genetic drift, both of which have historically been taken to be ‘chancy’ in a number of different (...) senses. However,contrathe gesturing of contingency-theorists, chance variation and genetic drift are not always strong sources of contingency, as they can be non-chancy in at least one sense that opposes evolutionary contingency. The probabilistic conception offered herein allows for sources of contingency to appropriately vary in strength. To this end, I import Shannon’sinformation entropyas a statistical measure for systematically assessing the strength of a source of contingency, which is part and parcel of identifying sources of contingency. In brief, the higher the entropy, the greater the strength. This is also empirically significant because molecular, mutational, and replicative studies often contain sufficient frequency or probability data to allow for entropies to be calculated. In this way, contingency-theorists can evaluate the strength of a source of contingency in real-world cases. Moreover, the probabilistic conception also makes conceptual room for the converse of sources of contingency: ‘sources of directionality’, which ought to be recognised, as they can interact with genuine sources of contingency in undermining evolutionary contingency. (shrink)

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers can freely discuss current and emerging deep brain stimulation technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in (...) its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury. (shrink)

Purpose: The aim of this research was to test whether Hong Kong science students would prefer a learning environment based on critical constructivism and whether a closer preferred-actual fit to such an environment would be associated with better learning outcomes. Method: The participants were 149 Hong Kong secondary school Chemistry students aged 16--19 years. They completed actual and preferred forms of a Chinese version of the Constructivist Learning Environment Survey and measures of self-efficacy and intrinsic value of their Chemistry course. (...) Their Chemistry examination scores were also obtained at the end of the course. Findings: Analysis showed that these students would prefer their Chemistry classrooms to be more personally relevant, to allow students more say and to share more control, and to encourage more negotiation with their teacher. Regression surface analysis showed that congruence of person environment fit did not influence examination results but was associated with greater valuing of the course and higher student self-efficacy. Research implications: Further research with a wider sampling from Hong Kong and elsewhere and focusing on other subject areas will be necessary to assess the generalizability of these findings. Practical implications: It seems that educational reforms based on critical constructivist principles may be of value in non-Western contexts. Original value: Educational reforms in Hong Kong and elsewhere currently are based on traditional constructivist principles. But this is the first research to support a more radical approach in what is usually regarded as a relatively conservative Asian educational context. (shrink)

In this essay, I introduce the symposium on Jordan Wessling’s book, Love Divine: A Systematic Account of God’s Love for Humanity, by discussing its origin as a book panel, providing the context for the significance of Wessling’s contribution, and previewing the essays that follow.

Trenton Merricks has objected to dualist conceptions of the Incarnation in a similar way to Jaegwon Kim’s pairing problem. On the original pairing problem, so argues Kim, we lack a pairing relationship between bodies and souls such that body A is causally paired with soul A and not soul B. Merricks, on the other hand, argues that whatever relations dualists propose that do pair bodies and souls together (e.g. causal relations) are relations that God the Son has with all bodies (...) whatsoever via his divine attributes (e.g. God the Son could cause motion in any and all bodies via his omnipotence). So if we count these relations as sufficient for embodiment, then dualism implies that God the Son is embodied in all bodies whatsoever. I shall argue that while the original pairing problem might be easily answerable, the Christological pairing problem is not and that dualists must shift some of their focus from the defense of the soul’s existence to explicating the nature of the mind-body relationship. (shrink)

Background: Freezing of gait is a common symptom in Parkinson’s disease and can be difficult to treat with dopaminergic medications or with deep brain stimulation. Novel stimulation paradigms have been proposed to address suboptimal responses to conventional DBS programming methods. Burst-cycling deep brain stimulation delivers current in various frequencies of bursts, while maintaining an intra-burst frequency identical to conventional DBS.Objective: To evaluate the safety and tolerability of BCDBS in PD patients with FOG.Methods: Ten PD subjects with STN or GPi DBS (...) and complaints of FOG were recruited for this single center, single blinded within-subject crossover study. For each subject, we compared 4, 10, and 15 Hz BCDBS to conventional DBS during the PD medication-OFF state.Results: There were no serious adverse events with BCDBS. It was feasible and straightforward to program BCDBS in the clinic setting. The benefit was comparable to conventional DBS in measures of FOG, functional mobility and in PD motor symptoms. BCDBS had lower battery consumption when compared to conventional DBS.Conclusions: BCDBS was feasible, safe and well tolerated and it has potential to be a viable future DBS programming strategy. (shrink)

The development of photodynamic therapy and anti-vascular endothelial growth factor agents have revolutionized the treatment of retinal diseases, transforming the retina subspecialty by ushering in an age of pharmacological treatments for a wide range of diseases, including age-related macular degeneration.

Within the philosophy of biology, Michael Scriven’s twins has become a well-known thought experiment, due to its being the impetus for various lines of discussion concerning the contentious definition of evolutionary fitness, the distinction between natural selection and genetic drift, and evolutionary environments. As one version of the story goes: two twins who, ex hypothesi, are genotypically and phenotypically the same are located side by side on a mountain. An unfortunate event ensues whereby a lightning strike kills one of the (...) twins, whilst the other twin survives. For added disparity, the surviving twin goes on to proliferate extensively by bearing a large number of offspring. Importantly, it is usually inferred, from the stipulations of the thought experiment, that the twins also have the same evolutionary fitness. The inference is important because the premise that the twins have the same fitness paves way for a number of influential views; most notably, it has led to the propensity interpretation of evolutionary fitness. (shrink)