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)

1. T'oegye wa Hip'ok'ŭrat'esŭ ka mannagi kkaji -- 2. Taehwa e ch'amyŏ hasin pundŭl -- 3. Che 1-il. 'Kojŏn muksang' : kijon ŭi palgyŏndŭl ŭl ch'ulbalchŏm ŭro samaya -- 4. Che 2-il. 'Chonjaeron': mom an ŭi param ŭn hohŭp, mom pak ŭi param ŭn konggi -- 5. Che 3-il. 'Chŏngsŏ haengdongnon': chari ŭi ch'ai ro inhae sŏro tarŭda -- 6. Che 4-il. 'Kongburon': chonjae haji annŭn ŭisul ŭn ŏpta -- 7. Che 5-il. 'Chihaengnon': maŭm i p'yŏnhaji anŭl ttae nŭn han (...) kŏrŭm kŏrŏra -- 8. Che 6-il. 'Yulliron': kajang hullyunghan ŭihak ŭn ŭihak ŭl p'iryo ro haji ank'e hanŭn kŏt -- 9. Che 7-il. 'Chilli nŭn kat'ŭn kot e': modŭn kŏt ŭi sijak kwa kkŭt ŭn hana ida -- 10. Hip'ok'ŭrat'esŭ myŏngŏndŭl. (shrink)

This collection of essays reflects the wide range of David Pingree's expertise in the scientific texts of Ancient Mesopotamia, Greece, India, Persia, and the medieval Arabic, Hebrew and Latin traditions. Both theoretical aspects and the practical applications of the exact sciences-in time keeping, prediction of the future, and the operation of magic-are dealt with. The book includes several critical editions and translations of hitherto unknown or understudied texts, and a particular emphasis is on the diffusion of scientific learning from one (...) culture to another, and through time. Above all, the essays show the variety and sophistication of the exact sciences in non-Western societies in pre-modern times. (shrink)

Beyond the Learning Curve reviews and considers the psychology of skill acquisition. In so doing the authors propose a whole new theory of mental function - demonstrating that the mind is subject to the same natural laws as the physical world. Accessibly written, 'Beyond the learning curve' is a thought provoking and challenging new text for students and researchers in the cognitive sciences.

For years now, learning has been at the heart of research within cognitive psychology. How do we acquire new knowledge and new skills? Are the principles underlying skill acquisition unique to learning, or similar to those underlying other behaviours? Is the mental system essentially modular, or is the mental system a simple product of experience, a product that, inevitably, reflects the shape of the external world with all of its specialisms and similarities? This new book takes the view that learning (...) is a major influence on the nature of the processes and representations that fill our minds. Throughout, the authors review and consider the areas of skill acquisition and lexical representation to illustrate the effects that practice can have on cognitive processes. They also draw parallels between theories in physical and biological domains to propose not only a new theory of mental function but also demonstrate that the mind is essentially subject to the same natural laws as the physical world. In so doing Speelman and Kirsner present a new perspective on psychology - one that identifies universal principles underlying all behaviours and one which contrasts markedly from our current focus on highly specific behaviours. Accessibly written, Beyond the Learning Curve is a thought provoking and challenging new text for students and researchers in the cognitive sciences. (shrink)

Vietnam is home to a prospering technology community and numerous enterprises that range from small start-ups to development giants. Virtually all public services are offered online. In fact, the country even has a system for e-residency and “data embassies.” This achievement derives in part from the nation’s transparent and enduring political preferences, but more importantly from Vietnamese law and its regulatory system regarding information, the digital general public, and intellectual property rights (IPR) protection. In this examination of the most pertinent (...) aspects of Vietnam’s digital economy legislation, this study explores the nation’s regulatory structure regarding copyright and patents within the context of digital transformation. The study discusses the relationship between foreign and national regulations in terms of IPR protection and the advancement of digitalization. Research on Vietnamese regulations and the practical application of major patent and copyright regulations has revealed that in many respects, the nation is highly reliant on the effective operation of a broader foreign institutional and legal framework. Thus, in the near future, technological advancement will necessitate the establishment of additional transnational regulatory systems. (shrink)

[1]. Nonmun p'yŏn -- [2-3]. Charyo p'yŏn, 1-2.

1-2. Charyo p'yŏn, 1-2 -- [3]. Nonmun p'yŏn.

This study aims to determine the motive that led to the establishment of Juche by Kim Il Sung amidst the influence of communism and its transformation into religion in North Korea. North Korea is a communist country dictated by Kim Jong-Un of the Kim dynasty and known for its cruelty. The country underwent several changes from Marxism-Leninism to familism to determine its strength in Juche. This ideology that acts as a religion was influenced and strengthened Kim Jong Il to Kim (...) Jong-Un and built by shifting the concept of marxism-Leninism to construct a new understanding of Juche. It will be demonstrated that this ideology was influenced by Confucianism, Christianity, Nationalism, Chinese Communism, and Russian Communism. In the modern era, imperialism was used as an ideological tool to restrict backwardness. This theory allegedly helped Kim Il-Sung establish a unitary, one-person rule over North Korea. ‘It will be examined whether Juche ideology is a tool the state has used to convince people of their government. Pronouncements, an intentional religion in which the people were to believe that their Ruler was a supreme human or an ideology that morphed into a religion’. It will be demonstrated that, when they started honoring Kim as their god, no other religion was permitted.Contribution: This research offers readers an understanding of the value of humanity in the binding ideology of Juche. However, the Juche Ideology can serve as a missiological bridge towards mission goals, which require the experience of spiritual, physical, and social liberation. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)