End-of-life decision making frequently occurs in the intensive care unit (ICU). There is a lack of information on how a do-not-resuscitate (DNR) order affects treatments received by critically ill patients in ICUs. The objectives of this study were: (1) to compare the use of life support therapies between patients with a DNR order and those without; (2) to examine life support therapies prior to and after the issuance of a DNR order; and (3) to determine the clinical factors that influence (...) the initiation of a DNR order in ICUs in Taiwan. A prospective, descriptive, and correlational study was conducted. A total of 202 patients comprising 133 (65.8%) who had a DNR order, and 69 (34.1%) who did not, participated in this study. In the last 48 hours of their lives, patients who had a DNR order were less likely to receive life support therapies than those who did not have a DNR order. Older age, being unmarried, the presence of an adult child as a surrogate decision maker, a perceived inability to survive ultimate discharge from the ICU, and longer hospitalization in the ICU were significant predictors of issuing a DNR order for critically ill patients. This study will draw attention to how, when, and by whom, critically ill patients’ preferences about DNR are elicited and honored. (shrink)

This study empirically examined the effects of ethical leadership and ethical climate on employee ethical behavior in the international port context using survey data collected from 128 respondents who worked in Taiwan International Ports Corporation in Taiwan. Research hypotheses were formulated from the previous literature and tested using structural equation modeling. Results indicated that ethical leadership had a significant impact on ethical climate and the ethical behavior of TIPC employees. Ethical climate was found to be positively associated with employee ethical (...) behavior. The theoretical and practical implications of the research findings are discussed. (shrink)

This paper investigates the association between board characteristics and the company’s corporate social responsibility assurance decision in China. By examining 2054 firm-years of Chinese listed companies with CSR reports from 2008 to 2012, we find that firms with a large board size, more female directors, and separation of CEO and chairman positions are more likely to engage in CSR assurance. Gender diversity also influences the CSR assurance provider choice. However, board independence and overseas background of the CEO do not affect (...) the CSR assurance decision. Inconsistent with our prediction, firms with foreign directors are less likely to engage in voluntary CSR assurance. In summary, this research provides in-depth insights into the determinants of Chinese firms’ voluntary CSR assurance. (shrink)

Most neuroimaging research in stroke rehabilitation mainly focuses on the neural mechanisms underlying the natural history of post-stroke recovery. However, connectivity mapping from resting-state fMRI is well suited for different neurological conditions and provides a promising method to explore plastic changes for treatment-induced recovery from stroke. We examined the changes in resting-state functional connectivity (RS-FC) of the ipsilesional primary motor cortex (M1) in 10 post-acute stroke patients before and immediately after 4 weeks of robot-assisted bilateral arm therapy (RBAT). Motor performance, (...) functional use of the affected arm, and daily function improved in all participants. Reduced interhemispheric RS-FC between the ipsilesional and contralesional M1 (M1-M1) and the contralesional-lateralized connections were noted before treatment. In contrast, greater M1-M1 functional connectivity and disturbed resting-state networks were observed after RBAT relative to pre-treatment. Increased changes in M1-M1 RS-FC after RBAT were coupled with better motor and functional improvements. Mediation analysis showed the pre-to-post difference in M1-M1 RS-FC was a significant mediator for the relationship between motor and functional recovery. These results show neuroplastic changes and functional recoveries induced by RBAT in post-acute stroke survivors and suggest that interhemispheric functional connectivity in the motor cortex may be a neurobiological marker for recovery after stroke rehabilitation. (shrink)

The purpose of this paper is to investigate the changes in core self-evaluation scores among Chinese employees during 2010–2019. We conducted a cross-temporal meta-analysis including 50 studies to evaluate the relationship between the year of data collection and levels of CSE. We found that correlations between levels of CSE and year of data collection were strong and positive. Regression results showed that the year of data collection could predict the CSE score when the mean sample age and sex ratio were (...) controlled. In addition, CSE scores were positively related to GDP per capita and negatively related to the unemployment rate. (shrink)

Background The use of lengthy, detailed, and complex informed consent forms is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in (...) biomedical research. Methods This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 to 5. Results Of the 2484 questionnaires distributed, 2113 were returned. The majority of respondents considered most elements required in the ICF to be ‘moderately important’ to ‘very important’ for their decision making. Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF. Conclusions Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF. (shrink)

Purpose Moral orientation can affect ethical decision-making. Very few studies have focused on whether medical education can change the moral orientation of the students. The purpose of the present study was to document the types of moral orientation exhibited by medical students, and to study if their moral orientation was changed after preclinical education. Methods From 2007 to 2009, the Mojac scale was used to measure the moral orientation of Taiwan medical students. The students included 271 first-year and 109 third-year (...) students. They were rated as a communitarian, dual, or libertarian group and followed for 2 years to monitor the changes in their Mojac scores. Results In both first and third-year students, the dual group after 2 years of preclinical medical education did not show any significant change. In the libertarian group, first and third-year students showed a statistically significant increase from a score of 99.4 and 101.3 to 103.0 and 105.7, respectively. In the communitarian group, first and third-year students showed a significant decline from 122.8 and 126.1 to 116.0 and 121.5, respectively. Conclusion During the preclinical medical education years, students with communitarian orientation and libertarian orientation had changed in their moral orientation to become closer to dual orientation. These findings provide valuable hints to medical educators regarding bioethics education and the selection criteria of medical students for admission. (shrink)

In this study, we examined the role of culture on early adolescents’ social reasoning about peer exclusion. A total of 80 U.S. and 149 Taiwanese early adolescents independently completed a social reasoning essay about peer exclusion. Analyses of the essays based on social-moral theories showed that U.S. students tended to reason about peer exclusion based on social conventional thinking whereas Taiwanese students were more attentive to personal and moral issues. Despite this difference, both groups of students referred to some common (...) social-moral concepts while reasoning about peer exclusion, including consideration of personal benefit, harming others’ welfare, personal concern, and punishment. The use of social reasoning strategies was similar across the two groups of students except that Taiwanese students relied more on judgment whereas U.S. students generated more alternative hypotheses. (shrink)

We explore the various ethical challenges that arise during the practical implementation of an emergency resource allocation protocol. We argue that to implement an allocation plan in a crisis, a hospital system must complete five tasks: (1) formulate a set of general principles for allocation, (2) apply those principles to the disease at hand to create a concrete protocol, (3) collect the data required to apply the protocol, (4) construct a system to implement triage decisions with those data, and (5) (...) create a system for managing the consequences of implementing the protocol, including the effects on those who must carry out the plan, the medical staff, and the general public. Here we illustrate the complexities of each task and provide tentative solutions, by describing the experiences of the Coronavirus Ethics Response Group, an interdisciplinary team formed to address the ethical issues in pandemic resource planning at the University of Rochester Medical Center. While the plan was never put into operation, the process of preparing for emergency implementation exposed ethical issues that require attention. (shrink)

Business moral values are defined as the personal moral values held by individuals who are engaged in business interactions. Direct supervisors may play an important role in shaping the business moral values of their subordinates. Using 264 supervisor— subordinate dyadic data from Taiwanese organizations, the study investigated the relationships among supervisor business moral values, subordinate business moral values, subordinate organizational commitment, job performance, and attendance. The results indicated that supervisor business moral values were positively associated with subordinate business moral values, (...) and that the latter mediated the relationship between the former and subordinate outcomes. Implications for business moral values research are discussed. (shrink)

This study aims to disclose how the magnetic resonance imaging neuroimaging approach has been applied in education studies, and what kind of learning themes has been investigated in the reviewed MRI neuroimaging research. Based on the keywords “brain or neuroimaging or neuroscience” and “MRI or diffusion tensor imaging or white matter or gray matter or resting-state,” a total of 25 papers were selected from the subject areas “Educational Psychology” and “Education and Educational Research” from the Web of Science and Scopus (...) from 2000 to 2019. Content analysis showed that MRI neuroimaging and learning were studied under the following three major topics and nine subtopics: cognitive function, science education, and brain development. As for the type of MRI neuroimaging research, the most frequently used approaches were functional MRI, followed by structural MRI and DTI, although the choice of approach was often motivated by the specific research question. Research development trends show that the neural plasticity theme has become more prominent recently. This study concludes that in educational research, the MRI neuroimaging approach provides objective and empirical evidence to connect learning processes, outcomes, and brain mechanisms. (shrink)

As the negative environmental impacts of transportation systems become more severe, governments and environmental groups are seeking more sustainable transportation options, such as replacing fuel-powered vehicles with electric vehicles and expanding public transportation systems to reduce the number of people driving on their own, in order to reduce the environmental impacts of transportation systems. At present, the rapid expansion of public transportation systems is not an easy task and requires a long period of time to plan for expansion and construction, (...) so people are increasingly looking to find means of transportation that meet sustainable conditions as solutions. In this context, electric bicycles are one of the solutions that people can choose, with benefits such as energy saving, carbon reduction, effective air pollution reduction, and simple and labor-saving riding. However, in Taiwan, despite the many benefits of electric bicycles, their popularity is not high. Therefore, this study focuses on the factors that affect the purchase of electric bicycles in Taiwan. The Influential Network Relation Map generated by the Z-based Decision-making Trial and Evaluation Laboratory technique is used to describe the influence relationships among the factors and to establish the key evaluation criteria of electric bicycle purchase intention. The results indicate that vehicle price, safety, motor performance, battery life, and battery durability are the most important factors in purchasing electric bicycles. Furthermore, the power of motor is considered as the factor that most significantly affects other criteria, while safety and price are most likely to be affected by other criteria. This study has contributed to academia and industry, for the dependency weights of these factors are set to provide a scientific and systematic way to show how consumers think in the decision-making process and to provide more reliable information and management implications for the electric bicycle industry. (shrink)

BackgroundThe therapeutic effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD) is related to the modulation of pathological neural activities, particularly the synchronization in the β band (13–35 Hz). However, whether the local β activity in the STN region can directly predict the stimulation outcome remains unclear.ObjectiveWe tested the hypothesis that low-β (13–20 Hz) and/or high-β (20–35 Hz) band activities recorded from the STN region can predict DBS efficacy.MethodsLocal field potentials (LFPs) were recorded in (...) 26 patients undergoing deep brain stimulation surgery in the subthalamic nucleus area. Recordings were made after the implantation of the DBS electrode prior to its connection to a stimulator. The maximum normalized powers in the theta (4–7 Hz), alpha (7–13 Hz), low-β (13–20 Hz), high-β (20–35 Hz), and low-γ (40–55 Hz) subbands in the postoperatively recorded LFP were correlated with the stimulation-induced improvement in contralateral tremor or bradykinesia–rigidity. The distance between the contact selected for stimulation and the contact with the maximum subband power was correlated with the stimulation efficacy. Following the identification of the potential predictors by the significant correlations, a multiple regression analysis was performed to evaluate their effect on the outcome.ResultsThe maximum high-β power was positively correlated with bradykinesia–rigidity improvement (rs = 0.549, p < 0.0001). The distance to the contact with maximum high-β power was negatively correlated with bradykinesia–rigidity improvement (rs = −0.452, p < 0.001). No significant correlation was observed with low-β power. The maximum high-β power and the distance to the contact with maximum high-β power were both significant predictors for bradykinesia–rigidity improvement in the multiple regression analysis, explaining 37.4% of the variance altogether. Tremor improvement was not significantly correlated with any frequency.ConclusionHigh-β oscillations, but not low-β oscillations, recorded from the STN region with the DBS lead can inform stimulation-induced improvement in contralateral bradykinesia–rigidity in patients with PD. High-β oscillations can help refine electrode targeting and inform contact selection for DBS therapy. (shrink)

Growing demand for direct care workers to assist care-dependent elderly people has created an opening for migrant workers from low- income nations to sell their services to middle and high-income nations. Using Singapore as a case example, we draw on capability theory to make the case that receiving nations that import direct care workers should be held to global justice standards that protect workers’ floor level human capabilities. Specifically, we (1) show that Singapore and other receiving nations fail to protect (...) human capabilities at a threshold level required by dignity; (2) identify specific human capabilities placed at risk; and (3) recommend standards for receiving nations that support central capabilities. As populations in both developed and developing nations are rapidly aging, these concerns could not be timelier. (shrink)

Digitalization and advanced technologies are replacing human jobs. Around the world, many people have lost their jobs due to increasing digitalization. Similarly, Chinese expatriates associated with the manufacturing sector in emerging countries such as Vietnam face similar challenges. Therefore, Chinese expatriates need to bring competitiveness in their competencies. This competitiveness brings sustainability to their career. The aim of this study is to investigate the impact of career competencies on career sustainability. Moreover, we test the mediating effect of lifelong learning in (...) the relationship between career competencies and career sustainability. A questionnaire survey approach was used in this study. The target population was the Chinese expatriate managers working at China-invested manufacturing multinational organizations in Vietnam. To estimate the proposed relationships, we use structural equation modeling. The results are confirmed that in the direct relationship career competence has a positive impact on career sustainability. The findings of this study also indicate that career competencies have a positive impact on lifelong learning. Furthermore, outcomes confirmed that lifelong learning has a positive impact on career sustainability. Similarly, results are also confirmed that lifelong learning is positively mediating between career competencies and career sustainability. Therefore, the empirical results of this article identify that lifelong learning has a critical impact on sustainable careers. Specifically, this study is useful for mid-level managers who are associated with multinational organizations. At the end of this article, we also explained the practical implications, limitations, and future research directions. (shrink)

Career sustainability is a well-researched issue in academics and other sectors. Technology advancements and COVID-19 have jeopardized career sustainability. Numerous studies have explored the influence of individual characteristics on career sustainability, but few have focused on leadership. In addition, cultural factors must be considered because leadership is rooted in culture. In particular, inclusive leadership reflects traditional Chinese culture. Therefore, based on self-determination social exchange theories, we analyzed the effects of inclusive leadership on career sustainability as well as the roles of (...) thriving at work and supervisor developmental feedback in career sustainability. In total, 363 samples were collected from China. The results revealed that inclusive leadership improves career sustainability through SDF and thriving at work. Theoretically, our study fills the research gap and establishes a mechanism and theoretical framework for inclusive leadership and career sustainability. Practically, we offer guidance for enterprises to cultivate inclusive leadership and improve career sustainability. (shrink)

This volume brings together a group of logic-minded philosophers and philosophically oriented logicians to address a diversity of topics on the structural analysis of non-classical logics. It mainly focuses on the construction of different types of models for various non-classical logics of current interest, including modal logics, epistemic logics, dynamic logics, and observational predicate logic. The book presents a wide range of applications of two well-known approaches in current research: structural modeling of certain philosophical issues in the framework of non-classic (...) logics, such as admissible models for modal logic, structural models for modal epistemology and for counterfactuals, and epistemological models for common knowledge and for public announcements; conceptual analysis of logical properties of, and formal semantics for, non-classical logics, such as sub-formula property, truthmaking, epistemic modality, behavioral strategies, speech acts and assertions. The structural analysis provided in this volume will appeal not only to graduate students and experts in non-classic logics, but also to readers from a wide range of disciplines, including computer science, cognitive science, linguistics, game theory and theory of action, to mention a few. (shrink)

While an increasing number of organizations have introduced artificial intelligence as an important facilitating tool for learning online, the application of artificial intelligence in e-learning has become a hot topic for research in recent years. Over the past few decades, the importance of online learning has also been a concern in many fields, such as technological education, STEAM, AR/VR apps, online learning, amongst others. To effectively explore research trends in this area, the current state of online learning should be understood. (...) Systematic bibliometric analysis can address this problem by providing information on publishing trends and their relevance in various topics. In this study, the literary application of artificial intelligence combined with online learning from 2010 to 2021 was analyzed. In total, 64 articles were collected to analyze the most productive countries, universities, authors, journals and publications in the field of artificial intelligence combined with online learning using VOSviewer through WOS data collection. In addition, the mapping of co-citation and co-occurrence was explored by analyzing a knowledge map. The main objective of this study is to provide an overview of the trends and pathways in artificial intelligence and online learning to help researchers understand global trends and future research directions. (shrink)

PurposeThis study aims to describe the adverse events following immunization of SARS-CoV-2 vaccination in cancer patients/survivors associated with their psychological distress.MethodsA cross-sectional study was conducted to assess AEFIs after the receipt of SARS-CoV-2 vaccines in cancer patients/survivors attending a university hospital in Malaysia. Psychological distress was measured using the Hospital Anxiety and Depression Scale before and after the first and second doses of COVID-19 vaccine.ResultsA total of 217 complete responses were received. Compared with before vaccination, both HADS Anxiety and HADS (...) Depression scores were significantly reduced after the first and second dose of the SARS-CoV-2 vaccine. Most of the participants had mild-or-moderate systemic and local AEFIs, with the most common being pain at the injection site, tiredness, and headache for both the first and second doses of the vaccine. Positive correlations between the total AEFI score and HADS-A and HADS-D scores were observed after the first dose of the SARS-CoV-2 vaccine. Similarly, positive associations were observed between the total AEFI score and HADS-A and HADS-D scores after the second dose of the SARS-CoV-2 vaccine.ConclusionMild-to-moderate AEFIs found in this study help address vaccine hesitancy in cancer patients/survivors. Receiving the SARS-CoV-2 vaccine had a positive effect on decreasing psychological distress in cancer patients/survivors. High severity of an AEFI was associated with higher anxiety and depressive symptoms. (shrink)

Background: Healthcare workers in the front line of diagnosis, treatment, and care of patients with coronavirus disease 2019 are at great risk of both infection and developing mental health symptoms. This study aimed to investigate the following: whether healthcare workers in general hospitals experience higher mental distress than those in psychiatric hospitals; the role played by religion and alexithymic trait in influencing the mental health condition and perceived level of happiness of healthcare workers amidst the stress of the COVID-19 pandemic; (...) and factors that influence the resilience of healthcare workers at 6 weeks' follow-up.Methods: Four-hundred and fifty-eight healthcare workers were recruited from general and psychiatric hospitals, and 419 were followed-up after 6 weeks. All participants filled out the 20-item Toronto Alexithymia Scale, five-item Brief-Symptom Rating Scale, and the Chinese Oxford Happiness Questionnaire.Results: Under the stress of the COVID-19 pandemic, 12.3% of frontline healthcare workers in general hospitals reported having mental distress and perceived lower social adaptation status compared with those working in psychiatric hospitals. Christians/Catholics perceived better psychological well-being, and Buddhists/Taoists were less likely to experience mental distress. The results at 6 weeks of follow-up showed that the perceived lower social adaptation status of general hospital healthcare workers was temporary and improved with time. Christian/Catholic religion and time had independent positive effects on psychological well-being; however, the interaction of Christian/Catholic religion and time had a negative effect.Conclusions: Collectivism and individualism in the cultural context are discussed with regard to alexithymic trait and Buddhist/Taoist and Christian/Catholic religious faiths. Early identification of mental distress and interventions should be implemented to ensure a healthy and robust clinical workforce for the treatment and control of the COVID-19 pandemic. (shrink)

To date, game-based learning programs that include comprehensive creativity skills and disposition training are still very limited. The present researchers developed a comprehensive game-based creativity learning program for fifth and sixth grade pupils. Further analysis presented relationship trends between mindful learning experience, flow experience, self-efficacy, and mastery experience. Eighty-three 5th and 6th grade participants undertook the six-week game-based creativity learning program. Upon the completion of experimental instruction, those who scored higher on the concerned variables improved more in self-evaluation of both (...) creativity ability and confidence, than their counterparts. Additionally, path model analysis revealed that mindful learning experience was a powerful predictor of both mastery experience and flow experience; it also influenced mastery experience through flow experience and self-efficacy during game-based creativity learning. The findings support the effectiveness of the game-based learning program developed in this study. Moreover, this study contributes to the theoretical construction of how game-based learning can be designed to facilitate mindful learning experience, flow experience, self-efficacy, and mastery experience during creativity training among pupils. Effective mechanisms include providing rewards for high-quality performance, challenging tasks, free choices of design components, immediate feedback, and idea sharing. The profound theoretical framework proposed in this study provides a valuable approach for creativity instruction through game-based learning or classroom instruction. (shrink)

Accurate short-term traffic flow modeling is an essential prerequisite to analyze and control traffic flow. Canonical data-driven methods are a large account of parameters that may be underfitted with limited training samples, yet they cannot adaptively boost their understanding of the spatiotemporal dependencies of the traffic flow. The noisy and unstable traffic flow data also prevent the models from effectively learning the underlying patterns for forecasting future traffic flow. To address these issues, we propose an easy-to-implement yet effective boosting model (...) based on extreme gradient boosting and enhance it by wavelet denoising for short-term traffic flow forecasting. The discrete wavelet denoising is employed to preprocess the noisy traffic flow data. Then, the denoised training datasets are reconstructed to train the extreme gradient boosting model. These two components are integrated seamlessly in a unified framework, and the whole framework can retain the features in the data as much as possible. Our model can precisely capture the hidden spatial dependency in the data. Extensive experiments are conducted on four benchmark datasets compared with frequently used models. The results demonstrate that the proposed model can precisely capture the hidden spatial dependency of the traffic flow data and achieve superior performance. (shrink)