The aim of this study was to compare the learning effectiveness of peer tutored problem-based learning and conventional teaching of nursing ethics in Taiwan. The study adopted an experimental design. The peer tutored problem-based learning method was applied to an experimental group and the conventional teaching method to a control group. The study sample consisted of 142 senior nursing students who were randomly assigned to the two groups. All the students were tested for their nursing ethical discrimination ability both before (...) and after the educational intervention. A learning satisfaction survey was also administered to both groups at the end of each course. After the intervention, both groups showed a significant increase in ethical discrimination ability. There was a statistically significant difference between the ethical discrimination scores of the two groups (P < 0.05), with the experimental group on average scoring higher than the control group. There were significant differences in satisfaction with self-motivated learning and critical thinking between the groups. Peer tutored problem-based learning and lecture-type conventional teaching were both effective for nursing ethics education, but problem-based learning was shown to be more effective. Peer tutored problem-based learning has the potential to enhance the efficacy of teaching nursing ethics in situations in which there are personnel and resource constraints. (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 study proposed and examined a conceptual framework on the influence of real estate brokers’ personalities, psychological empowerment, social capital, and knowledge sharing on their innovation performance, and used moral hazard as a moderating variable. We used structural equation modeling for data analysis and estimation. The participants were real estate brokers in Kaohsiung City. A total of 1,000 questionnaires were administered to 100 branch offices of real estate companies, 571 of which were later recovered from 80 branch offices. After removing (...) 52 for being invalid, we were left with 519 valid questionnaires, indicating a 51.9% recovery rate. The empirical results suggest that the real estate brokers’ personalities and psychological empowerment positively and significantly influence social capital; personality and psychological empowerment also positively and significantly influence their innovation performance; and social capital significantly influences knowledge sharing, which in turn positively and significantly influences the brokers’ innovation performance. In environments with higher levels of moral hazard, the influence of social capital on the brokers’ knowledge sharing is significantly diminished. (shrink)

Selections from the sayings of Zhuangzi rendered into cartoon form and translated into English.

This paper is a short report about a series of picture books and manuals designed for P4C (especially Philosophy for Korean Young Children). There were not proper educational reading materials or books to help Korean young children to think by (or for) themselves and dialogue with. Dr. Sharp’s is a very helpful guidebook for young children to think by themselves, dialogue with friends, and discuss with others (peers, older or younger children, teacher and parents, etc.). However, there remain some needs (...) for consideration of Korean culture. I developed new eight picture books for young children and short manuals for parents and teachers to do ‘thinking experiments’ with children. The stories were created in the contexts of Korean young children’s daily lives and typical episodes. The community of inquiry, which Korean young children participate in, needs to consider general and special aspects, such as the relationship between peers, children-parents, and children-teachers, Confucius or new western customs, new and old generations, moral and cultural atmosphere of Korean kindergartens or childcare centers, etc. Various episodes and scenes in the picture books will revoke and encourage Korean children’s deeper or higher thinking, interesting and creative dialogues, vivid and harmonious discussions based on their own experiences and contexts of life in the community of inquiry. (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 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)

This study aimed to develop cross-domain deep learning courses of artificial intelligence in vocational senior high schools and explore its impact on students’ learning effects. It initially adopted a literature review to develop a cross-domain SPOC-AIoT Course with SPOC and the Double Diamond 4D model in vocational senior high schools. Afterward, it adopted participatory action research and a questionnaire survey and conducted analyses on the various aspects of the technology acceptance model by SmartPLS. Further, this study explored the impact on (...) the effects of deep learning and knowledge-ability learning of artificial intelligence after 16 weeks of course teaching among 36 Grade I students from the electrical and electronic group of a vocational senior high school. This study revealed that the four stages of the SPOC-AIoT Teaching Mode of the Double Diamond 4D model may effectively guide students to learn AIoT knowledge and skills. Based on the technology acceptance model, the analysis of learning and participation in SmartPLS indicated that this model conformed to the academic fitness requirements of the overall model. After learning with the SPOC-AIoT Teaching Mode, the learning effects of students in AIoT have been significantly improved to a positive aspect. Finally, some suggestions were put forward to promote the development of the SPOC-AIoT Teaching Mode Course in the future. (shrink)

Is it possible that there are extended simples—material objects extended in space or spacetime that have no proper parts? The most commonly cited argument for this possibility is based on a version of the Humean principle: namely (and with some qualifications), any pattern of instantiation of a fundamental relation is possible. In this paper, we make the Humean argument fully explicit, and criticise it from three aspects—the Disjunction problem, the Pluralist problem, and the Accidentality problem. First, the original argument only (...) shows a disjunctive thesis: either extended simples are possible, or unextended complexes are possible. In order to reach the desired conclusion, some additional premise is needed. Yet, even though we agree that the Disjunction problem can be met, we argue that the Humean argument fails to establish the possibility of extended simples, for two reasons: the first comes from compositional pluralism, and the second is about the definition of accidental properties. We contend that the latter two problems put the proponents of the Humean argument in serious difficulty. Thus, metaphysicians who hold that there are extended simples should find better arguments for this view. (shrink)

To many, recent allegations of accounting fraud (or earnings management; EM) at Enron, coupled with similar ones at many other corporations, are a strong indication of a serious decay in business ethics. In academics, this raises the concern between EM and corporate social responsibility (CSR). Since it has neither been documented, nor globally tested whether CSR mitigates or increases the extent of EM, three kinds of EM are studied: earnings smoothing, earnings aggressiveness, and earnings losses and decreases avoidance. The extents (...) to which financial characteristics and institutional variables have an impact on the extent to which companies conduct EM are also tested. Our study investigates whether the CSR-related features of 1,653 corporations in 46 countries had a positive or negative effect on the quality of their publicly released financial information during the 1993-2002 period. There is no question that with a greater commitment to CSR, the extent of earnings smoothing is mitigated, that of earnings losses and decreases avoidance is reduced, but the extent of earnings aggressiveness is increased. (shrink)

Urban streetscapes are outdoor areas in which the general public can appreciate green landscapes and engage in outdoor activities along the street. This study tested the extent to which the degree of awareness of urban street trees impacts attention restoration and perceived restorativeness. We manipulated the degree of awareness of street trees. Participants were placed into four groups and shown different images: (a) streetscapes with absolutely no trees; (b) streetscapes with flashes of trees in which participants had minimal awareness of (...) the content; (c) streetscapes with trees; and (d) streetscapes with trees to which participants were told to pay attention. We compared the performance of 138 individuals on measures of attention and their evaluations of perceived restorativeness. Two main findings emerged. First, streetscapes with trees improved the performance of participants on attentional tests even without their awareness of the trees. Second, participants who had raised awareness of street trees performed best on the attentional test and rated the streetscapes as being more restorative. These findings enhance our knowledge about the role of an individual's awareness of restorative elements and have implications for designers and individuals who are at risk of attentional fatigue. (shrink)

Over the past two decades, Victor and Cullen's (Adm Sci Q 33:101-125, 1988) typology of ethical climates has been employed by many academics in research on issues of ethical climates. However, little is known about how managerial practices such as communication and empowerment influence ethical climates, especially from a functional perspective. The current study used a survey of employees from Taiwan's top 100 patent-owning companies to examine how communication and empowerment affect organizational ethical climates. The results confirm the relationship between (...) these two managerial practices and organizational ethical climates. We discuss our results and their implications for both future academic research and practice. (shrink)

Physicians play a substantial role in facilitating communication regarding life-supporting treatment decision-making including do-not-resuscitate in the intensive care units. Physician-related fact...

Background Relational autonomy is an alternative concept of autonomy in which an individual is recognized as embedded into society and influenced by relational factors. Social context, including social location, political structure, and social forces, significantly influence an agent to develop and exercise autonomy skills. The relational approach has been applied in clinical practice to identify relational factors impacting patient autonomy and decision-making, yet there is a knowledge gap in how these factors influence the demonstration of relational autonomy in the context (...) of medical decisions of adults. Objective The present study targeted the existing knowledge of what and how relational factors impact individuals making medical decisions using the theoretical framework of relational autonomy. Methods A meta-synthesis study was utilized. Four electronic databases, including Embase, OVID Medline, CINAHL, and PubMed, were searched, along with gray literature and reference lists, to identify relevant studies. Results 23 studies reporting 21 qualitative and two mixed-method studies were reviewed. Four themes emerged from the qualitative findings: (1) supportive relationships facilitate an individual’s relational autonomy; (2) obtaining comprehensive information from broader sources helps individuals exercise relational autonomy; (3) undue family pressure impedes the exercising of patient relational autonomy; and (4) healthcare providers’ dominant voice hampers the demonstration of relational autonomy. Conclusions Applying relational autonomy to assist adults in making well-considered decisions is essential. The meta-synthesis suggests establishing a supportive relationship between individuals, healthcare providers, and family. A supportive relationship will allow healthcare providers to make judgments in line with an individual’s values and wishes with the aim of promoting relational autonomy. Advance care planning was proposed as the effective solution to obtain a consensus between individuals and their families while respecting an individual’s values and preferences. Furthermore, it is considered crucial for healthcare providers to appreciate an individual's values and incorporate their preferences into recommendations. (shrink)

The relationships between age and the life-supporting treatments use, and between gender and the life-supporting treatments use are still controversial. Using extracorporeal membrane oxygenation as an example of life-supporting treatments, the objectives of this study were: to examine the relationship between age and the extracorporeal membrane oxygenation use; to examine the relationship between age and the extracorporeal membrane oxygenation use; and to deliberate the ethical and societal implications of age and gender disparities in the initiation of extracorporeal membrane oxygenation. This (...) is a population-based, retrospective cohort study. Taiwan’s extracorporeal membrane oxygenation cases from 2000 to 2010 were collected. The annual incidence rate of extracorporeal membrane oxygenation use adjusting for both age and gender distribution for each year from 2000 to 2010 was derived using the population of 2000 as the reference population. The trend of extracorporeal membrane oxygenation use was examined using time-series linear regression analysis. We conducted joinpoint regression for estimating the trend change of extracorporeal membrane oxygenation use. The trends of extracorporeal membrane oxygenation use both for different gender groups, and for different age groups have been significantly increasing over time. Men were more likely to be supported by extracorporeal membrane oxygenation than women. Women’s perspectives toward life and death, and women’s perception of well-being may be associated with the phenomenon. In addition, the patients at the age of 65 or older were more likely to be supported by extracorporeal membrane oxygenation than those younger than 65. Family autonomy/family-determination, and the Confucian tradition of filial piety and respecting elders may account for this phenomenon. This study showed gender and age disparities in the initiation of extracorporeal membrane oxygenation use in Taiwan, which may be accounted for by the cultural and societal values in Taiwan. For a healthcare professional who deals with patients’/family members’ medical decision-making to initiate life-supporting treatments, he/she should be sensitive not only to the legality, but also the societal and ethical issues involved. (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)

Background and aimDuring the COVID-19 pandemic, an Internet-Mindfulness-Based Stress Reduction program was delivered and may be better than an in-person approach. Our study evaluated the effects of iMBSR intervention on mental health, self-efficacy, and body image in women with breast cancer in Taiwan.Materials and methodsSixty-seven women with breast cancer were allocated to a 6-week iMBSR program or a waitlist control group, without heterogeneity between group characteristics. Patients from both groups were measured at baseline and postintervention using three scales: Depression, Anxiety, (...) and Stress Scale, General self-efficacy scale, and Body Image Scale. Descriptive dataset analysis, paired t-test, and Student’s t-test were used to evaluate the data.ResultsAlthough iMBSR did not significantly improve depression and stress between groups, iMBSR could improve anxiety with medium effect sizes. Significant benefits were found for body image and self-efficacy, with large effect sizes.ConclusionOur preliminary study supports iMBSR as a program that can improve mental health, body image, and self-efficacy in women with breast cancer. During the COVID-19 pandemic, medical professionals can use Internet-based clinical health education. (shrink)