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)

Background: High ethical sensitivity positively affects the quality of nursing care; nevertheless, Chinese nurses’ ethical sensitivity and the factors influencing it have not been described. Research objectives: The purpose of this study was to describe ethical sensitivity and to explore factors influencing it among Chinese-registered nurses, to help nursing administrators improve nurses’ ethical sensitivity, build harmony between nurses and patients, and promote the patients’ health. Research design: This was a descriptive, cross-sectional study. Participants and research context: We recruited 500 nurses (...) from several departments in three tertiary hospitals. The Chinese Moral Sensitivity Questionnaire–Revised version and the Jefferson Scale of Empathy-Health Professionals were used to assess the nurses’ ethical sensitivity and empathy ability, respectively. Fifteen sociodemographic variables were included in the questionnaires. Ethical considerations: Informed consent was obtained from the participants regarding participation and data storage and handling. This program has been examined and supported by the research center of medical ethics and professional ethics of Guilin Medical University. The Approval No. was 2016RWYB04. The whole research process is conducted strictly according to ethical requirements. Results: The valid response rate was 84.40% ( n = 422). The total score of Chinese Moral Sensitivity Questionnaire–Revised was 35.82 ± 8.17. The subscale scores of moral responsibility and strength and sense of moral burden were 21.50 ± 4.91 and 14.33 ± 3.98, respectively. Significant differences were found among age groups, gender, years of working, category of profession, and quality of family communication regarding nurses’ ethical sensitivity ( p < 0.05). Regression analysis showed that the main factors influencing nurses’ ethical sensitivity were gender, years of working, quality of family communication, career satisfaction, and empathic ability. Discussion: Our findings suggest that Chinese nurses’ ethical sensitivity in tertiary hospitals in Guilin is at a medium level. Conclusion: The director of nursing schools and hospitals in China should pay attention to nurses’ ethical sensitivity and should intensify education and training to improve nurses’ ethical sensitivity. Further studies should focus on interventions aimed at improving Chinese nurses’ ethical sensitivity. (shrink)

Respect for patient autonomy is paramount in resolving ethical tensions in end-of-life care. The concept of relational autonomy has contributed to this debate; however, scholars often use this concept in a fragmented manner. This leads to partial answers on ascertaining patients’ true wishes, meaningfully engaging patients’ significant others, balancing interests among patients and significant others, and determining clinicians’ obligations to change patients’ unconventional convictions to enhance patient autonomy. A satisfactory solution based on relational autonomy must incorporate patients’ competence (apart from (...) decisional capacity), authenticity (their true desires or beliefs) and the involvement level of their significant others. To that end, we argue that John Christman’s procedural approach to relational autonomy provides critical insights, such as the diachronic or socio-historical personhood, sustained critical reflection and his recent explication of the nature of asymmetrical relationships and helpful interlocutors. This study reviews Christman’s account, proposes minor modifications and advocates for an integrated three-dimensional model for medical decision-making. Clarifying the relationship among the three elements promotes an ethical framework with a coherent understanding of relational autonomy. This model not only provides a descriptive and normative framework for end-of-life care practice but also reconsiders the nature of the clinician–patient relationship and its normative implications. We further present a case study to illustrate the merits of our proposed model. Altogether, our proposal will help navigate complex medical decision-making, foster trust and negotiate shared values between patients and their significant others, particularly in end-of-life care. (shrink)

The financial crisis of 2007–2008 and the COVID-19 pandemic have caused many enterprises to suffer great losses. Thus, companies have to take measures such as pays cut, furloughs, or layoffs, which caused dissatisfaction among employees and triggered labor disputes. Therefore, this study explores the service-oriented organizational citizenship behavior based on the decomposed theory of planned behavior in order to understand the behavioral intentions of employees through their mental states, job attitudes, subjective norms, and perceived behavioral control. This study conducted questionnaire (...) surveys for employees in different industries, collected 281 valid questionnaires, and applied Structural Equation Model for the analysis. The results show: employees believe organizational justice in the organization is important, and when they feel treated fairly, their job attitudes and beliefs are enhanced. Employees’ job attitudes and beliefs support service-oriented organizational citizenship behavior, in other words, they have positive job attitudes and beliefs and will actively provide better service to customers. When employees are treated reasonably and fairly by the organization and have positive job attitudes and perceived behavior control, their spontaneous service-oriented organizational citizenship behavior is stimulated, thus increasing organizational development. (shrink)

This dissertation is a study in Peirce's early metaphysics embedded in his writings between 1859 and 1867, which have received scant attention. Its purpose is to unravel his concept of reality and some relevant epistemological notions. Peirce's early metaphysical speculations can be divided into two parts. One is a system which covers thought between 1859 and 1862. The other manifests in lectures and writings between 1863 and 1867. The present study, consisting of five chapters, includes both of them. ;Murray G. (...) Murphey is one of the very few scholars who have attempted to take Peirce's early theories of knowledge and reality seriously. Thus the first chapter delineates his general interpretation of Peirce's first system, as a base for further discussions in the next two chapters. The second chapter clarifies Peirce's notion of metaphysics and then criticizes Murphey's understanding of Peirce's view of metaphysics. Similarly, the task of the third chapter is twofold: on the one hand, focusing on the epistemological and metaphysical issues, it provides an exposition of Peirce's system in detail and shows that some of his philosophical doctrines can be traced back to that system; on the other hand, it critically examines Murphey's interpretations of Peirce's texts and demonstrates that they involve misunderstandings or are one-sided. The fourth chapter scrutinizes Peirce's early writings on logic, which is regarded as a branch of semiotic and the foundation of metaphysics. It first elucidates Peirce's unpsychological view of logic as well as his notion of symbol and then discloses his theory of individual and diachronic view of knowledge therein embedded. Furthermore, Peirce's thesis that the function of a proposition is to reduce the impression to unity is investigated. Finally, it sums up the epistemological and metaphysical significance of Peirce's logical theory above expounded and, especially, specifies the fundamental tenets of Peirce's concept of reality implicitly involved in his early semeiotical approach to logic. The last chapter is simply a brief conclusion, roughly adumbrating Peirce's later doctrine of reality and how, in many aspects, it is foreshadowed by his early thought. (shrink)

The study analyzes the influential factors of consumers’ willingness to purchase gray-market smartphones by considering the model of novelty seeking, status consumption, integrity, and perceived risk. Attitude toward counterfeit is used as mediation in the model. The causalities in the model of problematic willingness of consumer to purchase gray-market smartphones are hypothesized. A total sample of 350 respondents with 238 effective samples is collected by interviewing with questionnaires at the service counters of telecommunications operators. Structure equation modeling (SEM) is adopted (...) in the analysis. Consumers’ attitude toward counterfeit goods is found to be positively related to the willingness of consumers to purchase gray-market smartphones, but perceived risk is negatively related to consumers’ willingness to purchase. As for personality constructs, integrity and status consumption are found to be negatively related to consumers’ attitude toward counterfeit goods, but novelty seeking is positively related to the attitude. Further, managerial implications for branded smartphone manufacturers and telecommunications regulators are provided by the research. (shrink)

Based on the expanded theory of planned behavior, this study first explores the configuration relationship between founder management and innovation by using the fuzzy-set qualitative comparative analysis. Based on the theory of planned behavior, this study divides the behavior intention of founders into three categories: Attitude, subjective norm, and perceived behavior control. Using fsQCA, we found that there are two ways to achieve high innovation input of enterprises. In combination with the two ways, the factors such as male and highly (...) educated founder, and large firm size can effectively increase the innovation input of firms, which is consistent with the three aspects of the behavioral intention of the theory of planned behavior, and it proves that the theory of planned behavior can effectively explain the configuration relation between the founder and firm innovation. In addition, this study finds that the innovation output is different from the innovation input, is dependent on the innovation ability of the firm itself, and is less influenced by the external environment. (shrink)

Single crystal samples of n - deformed to a permanent strain of 2% at room temperature under multiple-slip conditions contain faulted dipoles whose density exhibits some dependence on load orientation. Although FDs are hard to observe after compression along [210], they are profuse and congregated in places in the [1 1 8.6] load orientation. They exhibit most of the topological characteristics of FDs formed under single slip as reported by Grégori and Veyssière such as elongation in the screw direction of (...) the primary d 011] slip direction and a noticeable shape asymmetry. It is shown further that, in the [1 1 8.6] samples, bundles of FDs originate at jogs that result from intersection with forest dislocations of appropriate Burgers vectors. A mechanism for FD nucleation is proposed on the basis of asymmetrical dissociation of the parent d 011] dislocation and specific impingements between the various partials on two adjacent octahedral planes. Implications of the FD nucleation at jogs on the load orientation dependence of the FD density are discussed. (shrink)

This study examines the effects of leader emotional intelligence, leadership styles, organizational commitment, and trust on job performance. A questionnaire was administered to the participants, who were real estate brokers in Kaohsiung City. Of the 980 questionnaires administered, 348 valid responses were received, indicating an effective response rate of 35.5%. Structural equation modeling was used for the analysis. The results show that leader emotional intelligence has a significant and positive effect on trust in supervisors, and transformational leadership and trust within (...) a team have significant and positive effects on job performance. In addition, organizational commitment has a significant and positive effect on job performance. Trust within a team mediates the significant and positive effect of leader emotional intelligence on job performance. Although transactional leadership has no direct, positive, and significant effects on employee job performance, trust in the workplace shaped by a leader’s leadership style will empower a team’s spirit and boost their morale, thereby indirectly affecting their job performance in a positive manner. (shrink)

Delineation of the subthalamic nuclei on MRI is critical for deep brain stimulation surgery in patients with Parkinson’s disease. We propose this retrospective cohort study for quantitative analysis of MR signal-to-noise ratio, contrast, and signal difference-to-noise ratio of the STN on pre-operative three-dimensional stereotactic MRI in patients with medication-refractory PD. Forty-five consecutive patients with medication-refractory PD who underwent STN-DBS surgery in our hospital from January 2018 to June 2021 were included in this study. All patients had whole-brain 3D MRI, including (...) T2-weighted imaging, T2-weighted fluid-attenuated inversion recovery, and susceptibility-weighted imaging, at 3.0 T scanner for stereotactic navigation. The signal intensities of the STN, corona radiata, and background noise were obtained after placing regions of interest on corresponding structures. Quantitative comparisons of SNR, contrast, and SDNR of the STN between MR pulse sequences, including the T2WI, FLAIR, and SWI. Subgroup analysis regarding patients’ sex, age, and duration of treatment. We used one-way repeated measures analysis of variance for quantitative comparisons of SNR, contrast, and SDNR of the STN between different MR pulse sequences, and we also used the dependent t-test for the post hoc tests. In addition, we used Mann–Whitney U test for subgroup analyses. Both the contrast and SDNR were highest on FLAIR. The SNR was highest on SWI, and both the SNR and SDNR were lowest on T2WI. Subgroup analyses demonstrated significantly lower SDNR on SWI for patients receiving medication treatment for ≥13 years. In conclusion, on 3D stereotactic MRI of medication-refractory PD patients, the contrast and SDNR for the STN are highest on FLAIR, suggesting the optimal delineation of STN on FLAIR. (shrink)

This study applies the concept of reported speech advanced by the renowned Russian literary scholar Mikhail Bakhtin to compare the argumentative styles of Mainland China and Taiwan. These societies in question are considered by many scholars as sharing the same argumentative style. The study reports that the Mainland debaters more frequently than the Taiwanese debaters maintained the authenticity of the quotations cited from ancient Confucian sources, whereas Taiwanese debaters paraphrased more frequently. On the other hand, this difference cannot be found (...) when debaters quoted from sources other than Ancient Confucians. The findings, according to Bakhtin, imply a contrast of monologic and dialogic tendencies toward authority, which results in a style difference between Mainland and Taiwan argumentation. (shrink)

With the continuous progress and penetration of automated data collection technology, enterprises and organizations are facing the problem of information overload. The demand for expertise in data mining and analysis is increasing. Self-efficacy is a pivotal construct that is significantly related to willingness and ability to perform a particular task. Thus, the objective of this study is to develop an instrument for assessing self-efficacy in data mining and analysis. An initial measurement list was developed based on the skills and abilities (...) about executing data mining and analysis, and expert recommendations. A useful sample of 103 university students completed the online survey questionnaire. A 19-item four-factor model was extracted by exploratory factor analysis. Using the partial least squares-structural equation modeling technique, the model was cross-examined. The instrument showed satisfactory reliability and validity. The proposed instrument will be of value to researchers and practitioners in evaluating an individual’s abilities and readiness in executing data mining and analysis. (shrink)

Pain has not only sensory, but also emotional and cognitive, components. Some studies have explored the effect of pain on time perception, but the results remain controversial. Whether individual pain-related emotional and cognitive factors play roles in this process should also be explored. In this study, we investigated the effect of electrical stimulation–induced pain on interval timing using a temporal bisection task. During each task session, subjects received one of five types of stimulation randomly: no stimulus and 100 and 300 (...) ms of non-painful and painful stimulation. Pain-related emotional and cognitive factors were measured using a series of questionnaires. The proportion of “long” judgments of a 1,200-ms visual stimulus duration was significantly smaller with 300 ms painful stimulation than with no stimulus and 100 ms and 300 ms non-painful stimulation. The point of subjective equality did not differ among sessions, but the average Weber fraction was higher for painful sessions than for no-stimulus session. The pain fear score correlated positively with the PSE under 100 ms non-painful and painful and 300 ms painful stimulation. Pain catastrophizing and pain anxiety scores correlated significantly with the WF under no stimulus and 100 ms non-painful stimulation, respectively. These results suggest that electrical stimulation–induced pain affects temporal sensitivity, and that pain-related emotional and cognitive factors are associated with the processing of time perception. (shrink)

Taiwan has a complete semiconductor industry chain and is important in global semiconductor manufacturing. In addition to considering operational conditions, companies have also attached importance to corporate social responsibility (CSR) in recent years. This research thus takes 60 integrated circuit (IC) companies in Taiwan as a research sample and adopts the Meta Two-stage dynamic RDM DDF (range directional model directional distance function) under an exogenous CSR model to explore their market stage efficiency and production stage efficiency. This study aimed to (...) analyze whether incorporating a company's CSR performance into performance evaluations affects the production and profitability efficiency of Taiwanese IC companies. The findings are as follows: Most IC companies practice CSR and demonstrate good CSR performance. The market stage efficiency and production stage efficiency of the IC packaging and testing group are better than those of other groups. (shrink)

Background: Informed consent is essential for the ethical conduct of clinical research and is a culturally sensitive issue. But, a measurable Chinese version of the scale to evaluate the informed consent process has not yet been explored in the existing literature. Research objectives: This study aimed to develop and psychometrically test the Chinese version of the Informed Consent Process Scale. Research design: Back-translation was conducted to develop the Chinese version of the questionnaire. A cross-sectional survey was administered, after which an (...) exploratory factor analysis was conducted. Participants: We recruited a total of 375 participants who had experience in signing an informed consent form within the previous 3 years in Taiwan. Ethical considerations: This study was approved by two Institutional Review Boards and the autonomy of the participants was respected. Findings: The Chinese version of the Informed Consent Process Scale is composed of three factors with 23 items showing evidence of acceptable reliability and validity. Three major factors were extracted and labeled: Factor 1 – ‘Understanding of the research’, Factor 2 – ‘Trust and confidence’ and Factor 3 – ‘Doubt and uncertainty’. The three factors accounted for is 52.954 of the total variance with Cronbach’s α of.917. Discussion and conclusion: The finding corroborates previous studies showing that participants had too little understanding on the informed consent forms they signed and implied the need to clarify the critical points in clinical research. The psychometric results indicated good internal consistency and validity for this newly constructed instrument, and it was found worthy of conducting further testing and application. (shrink)

Background This study used a scenario- and discussion-based approach to teach preclinical medical students the socio-philosophical aspects of psychiatry and qualitatively evaluated the learning outcomes in a medical humanities course in Taiwan. Methods The seminar session focused on three hypothetical psychiatry cases. Students discussed the cases in groups and were guided by facilitators from multiple disciplines and professions. At the end of the semester, students submitted a narrative report comprising their reflections on the cases and discussions. The authors utilized content (...) analysis to categorize students’ narratives into three facets, namely, the philosophical, social and individual. Results In total 163 preclinical medical students participated in the class; 150 of them mentioned the scenario-based lesson in their reports; 33.3% of these reports discussed the case at the philosophical dimension (n = 50), 45.3% at the social dimension (n = 68), and 26.6% at the individual dimension (n = 40). Four major themes emerged: (1) a psychiatric diagnosis has far-reaching consequences for an individual’s life, (2) the social structure affects how patients experience psychiatric disorders, (3) students related personal experience or those of friends and family to understand psychiatric disorders, and (4) medical humanities are of particular importance in psychiatric education. Conclusions This study demonstrated that the scenario-based discussions led by a multidisciplinary team of facilitators can benefit medical students with limited clinical experience to contemplate the socio-philosophical aspects of psychiatry. The authors suggest that this pedagogical model during preclinical education should be encouraged. (shrink)

Includes translations of the important manuscripts in silk found at the famous Mawangdui Tomb in 1973.

Exploring the amplitude modulation phenomenon of chaotic signal has become a subject of great concern in recent years. This paper mainly concentrates on the preliminary study on amplitude modulation principle of a chaotic system. First, two 3D chaotic systems with quadratic product terms are introduced for studying the amplitude modulation phenomenon of chaotic signal. It is found that the signal amplitude of the first system can be controlled by partial quadratic coefficient. But for the second system, none of nonlinear coefficient (...) can be employed to control the signal amplitude. Then, the amplitude modulation principle of chaotic system is preliminarily studied by exploring the intrinsic relationship between nonzero equilibrium point and phase space trajectory, and it is further validated by introducing unified parameter to the two 3D chaotic systems. As a necessary condition, the principle provides a feasible and simple method for constructing and analyzing an amplitude modulation chaotic system. (shrink)