The growing prevalence of health care ethics consultation (HCEC) services in the U.S. has been accompanied by an increase in calls for accountability and quality assurance, and for the debates surrounding why and how HCEC is evaluated. The objective of this study was to evaluate the effectiveness of HCEC as indicated by several novel outcome measurements in East Asian medical encounters.

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%. 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. 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)

An efficient intelligent fault diagnosis model was proposed in this paper to timely and accurately offer a dependable basis for identifying the rolling bearing condition in the actual production application. The model is mainly based on an improved butterfly optimizer algorithm- optimized kernel extreme learning machine model. Firstly, the roller bearing’s vibration signals in the four states that contain normal state, outer race failure, inner race failure, and rolling ball failure are decomposed into several intrinsic mode functions using the complete (...) ensemble empirical mode decomposition based on adaptive noise. Then, the amplitude energy entropies of IMFs are designated as the features of the rolling bearing. In order to eliminate redundant features, a random forest was used to receive the contributions of features to the accuracy of results, and subsets of features were set up by removing one feature in the descending order, using the classification accuracy of the SBOA-KELM model as the criterion to obtain the optimal feature subset. The salp swarm algorithm was introduced to BOA to improve optimization ability, obtain optimal KELM parameters, and avoid the BOA deteriorating into local optimization. Finally, an optimal SBOA-KELM model was constructed for the identification of rolling bearings. In the experiment, SBOA was validated against ten other competitive optimization algorithms on 30 IEEE CEC2017 benchmark functions. The experimental results validated that the SBOA was evident over existing algorithms for most function problems. SBOA-KELM employed for diagnosing the fault diagnosis of rolling bearings obtained improved classification performance and higher stability. Therefore, the proposed SBOA-KELM model can be effectively used to diagnose faults of rolling bearings. (shrink)

Identification of non-coding RNAs (ncRNAs) has been significantly improved over the past decade. On the other hand, semantic annotation of ncRNA data is facing critical challenges due to the lack of a comprehensive ontology to serve as common data elements and data exchange standards in the field. We developed the Non-Coding RNA Ontology (NCRO) to handle this situation. By providing a formally defined ncRNA controlled vocabulary, the NCRO aims to fill a specific and highly needed niche in semantic annotation of (...) large amounts of ncRNA biological and clinical data. (shrink)

Identification of non-coding RNAs (ncRNAs) has been significantly enhanced due to the rapid advancement in sequencing technologies. On the other hand, semantic annotation of ncRNA data lag behind their identification, and there is a great need to effectively integrate discovery from relevant communities. To this end, the Non-Coding RNA Ontology (NCRO) is being developed to provide a precisely defined ncRNA controlled vocabulary, which can fill a specific and highly needed niche in unification of ncRNA biology.

Extra-corporeal membrane oxygenation has been introduced to clinical practice for several decades. It is unclear how internet and newspapers portray the use of extra-corporeal membrane oxygenation. This study were: (1) to quantify the coverage of extra-corporeal membrane oxygenation use in newspapers and on the Internet; (2) to describe the characteristics of extra-corporeal membrane oxygenation users presented in newspaper articles and the Internet web pages in comparison with those shown in extra-corporeal membrane oxygenation studies in Taiwan; and (3) to examine the (...) survival rates of extra-corporeal membrane oxygenation users presented in newspaper articles and the Internet web pages in comparison with those in Taiwan and in the Extracorporeal Life Support Registry Report International Summary for January 2014. (shrink)

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)

BackgroundThe Public Health Service Increased Risk designation identified organ donors at increased risk of transmitting hepatitis B, hepatitis C, and human immunodeficiency virus. Despite clear data demonstrating a low absolute risk of disease transmission from these donors, patients are hesitant to consent to receiving organs from these donors. We hypothesize that patients who consent to receiving offers from these donors have decreased time to transplant and decreased waitlist mortality.MethodsWe performed a single-center retrospective review of all-comers waitlisted for liver transplant from (...) 2013 to 2019. The three competing risk events (transplant, death, and removal from transplant list) were analyzed. 1603 patients were included, of which 1244 (77.6%) consented to offers from increased risk donors.ResultsCompared to those who did not consent, those who did had 2.3 times the rate of transplant (SHR 2.29, 95% CI 1.88–2.79, p < 0.0001), with a median time to transplant of 11 months versus 14 months (p < 0.0001), as well as a 44% decrease in the rate of death on the waitlist (SHR 0.56, 95% CI 0.42–0.74, p < 0.0001). All findings remained significant after controlling for the recipient age, race, gender, blood type, and MELD. Of those who did not consent, 63/359 (17.5%) received a transplant, all of which were from standard criteria donors, and of those who did consent, 615/1244 (49.4%) received a transplant, of which 183/615 (29.8%) were from increased risk donors.ConclusionsThe findings of decreased rates of transplantation and increased risk of death on the waiting list by patients who were unwilling to accept risks of viral transmission of 1/300–1/1000 in the worst case scenarios suggests that this consent process may be harmful especially when involving “trigger” words such as HIV. The rigor of the consent process for the use of these organs was recently changed but a broader discussion about informed consent in similar situations is important. (shrink)

Children tend to produce words earlier when they are connected to a variety of other words along the phonological and semantic dimensions. Though these semantic and phonological connectivity effects have been extensively documented, little is known about their underlying developmental mechanism. One possibility is that learning is driven by lexical network growth where highly connected words in the child's early lexicon enable learning of similar words. Another possibility is that learning is driven by highly connected words in the external learning (...) environment, instead of highly connected words in the early internal lexicon. The present study tests both scenarios systematically in both the phonological and semantic domains across 10 languages. We show that phonological and semantic connectivity in the learning environment drives growth in both production‐ and comprehension‐based vocabularies, even controlling for word frequency and length. This pattern of findings suggests a word learning process where children harness their statistical learning abilities to detect and learn highly connected words in the learning environment. (shrink)

Customer bullying is a common phenomenon, causing short-term emotional distress or having long-term psychological impact on frontline employees of service enterprises, yielding either direct or indirect losses to service enterprises. While existing research has focused on the emotional and psychological impact of customer bullying on employees, little attention has been directed at the impact of customer bullying on negative employee behavior and internal mechanisms. In view of this, this paper draws on conservation of resources theory and discusses how and when (...) customer bullying can lead to unethical behaviors. Furthermore, the mediating role of job insecurity and the moderating effect of organizational identification are analyzed. In study 1, 181 valid questionnaire data were collected at two time points, and regression data analysis was used to explore the effect of customer bullying on unethical behaviors through job insecurity. In study 2, 212 employees were recruited to investigate the moderating effect of organizational identification between customer bullying and unethical behaviors through a scenario experimental study. The results reveal that customer bullying is positively related to employees’ job insecurity and unethical behaviors. Job insecurity partially mediates the positive relationship between customer bullying and unethical behaviors. Further, the regression analysis results indicate that the direct effect of customer bullying on unethical behaviors is moderated by organizational identification. This study provides theoretical guidance for entrepreneurs to reduce both employee job insecurity and unethical behavior. (shrink)

Risks and benefit evaluation for controlled human infection studies, where healthy volunteers are deliberately exposed to infectious agents to evaluate vaccine efficacy, should be explicit, systematic, thorough, and non‐arbitrary. Decision analysis promotes these qualities using four steps: (1) determining explicit criteria and measures for evaluation, (2) identifying alternatives to the study, (3) defining the models used to estimate the measures for each alternative, and (4) running the models to produce the estimates and compare the alternatives. In this paper, we describe (...) how decision analysis might be applied by funders and regulators, as well as by others contemplating the use of novel controlled human infection studies for vaccine development and evaluation. (shrink)

There are ethical obligations to conduct research that contributes to generalisable knowledge and improves reproductive health, and this should include embryo research in jurisdictions where it is permitted. Often, the controversial nature of embryo research can alarm ethics committee members, which can unnecessarily delay important research that can potentially improve fertility for patients and society. Such delay is ethically unjustified. Moreover, countries such as the UK, Australia and Singapore have legislation which unnecessarily captures low-risk research, such as observational research, in (...) an often cumbersome and protracted review process. Such countries should revise such legislation to better facilitate low-risk embryo research.We introduce a philosophical distinction to help decision-makers more efficiently identify higher risk embryo research from that which presents no more risks to persons than other types of tissue research. That distinction is between future person embryo research and non-future person embryo research. We apply this distinction to four examples of embryo research that might be presented to ethics committees.Embryo research is most controversial and deserving of detailed scrutiny when it potentially affects a future person. Where it does not, it should generally require less ethical scrutiny. We explore a variety of ways in which research can affect a future person, including by deriving information about that person, and manipulating eggs or sperm before an embryo is created. (shrink)

There are ethical obligations to conduct research that contributes to generalisable knowledge and improves reproductive health, and this should include embryo research in jurisdictions where it is permitted. Often, the controversial nature of embryo research can alarm ethics committee members, which can unnecessarily delay important research that can potentially improve fertility for patients and society. Such delay is ethically unjustified. Moreover, countries such as the UK, Australia and Singapore have legislation which unnecessarily captures low-risk research, such as observational research, in (...) an often cumbersome and protracted review process. Such countries should revise such legislation to better facilitate low-risk embryo research. We introduce a philosophical distinction to help decision-makers more efficiently identify higher risk embryo research from that which presents no more risks to persons than other types of tissue research. That distinction is between future person embryo research and non-future person embryo research. We apply this distinction to four examples of embryo research that might be presented to ethics committees. Embryo research is most controversial and deserving of detailed scrutiny when it potentially affects a future person. Where it does not, it should generally require less ethical scrutiny. We explore a variety of ways in which research can affect a future person, including by deriving information about that person, and manipulating eggs or sperm before an embryo is created. (shrink)

Twenty classes in ten schools with 627 sixth?grade students in five cities in Taiwan participated in this study. The research provides information on the performance differences among written computation, pictorial representation, symbolic representation and number sense. The results of One?way ANOVA analysis indicate that significant difference was found among WCT, PRT, SRT and NST tests, with F=536.327, p=0.000. The a posteriori comparisons show for each pair (WCT vs PRT, WCT vs SRT, WCT vs NST, PRT vs SRT and SRT vs (...) NST) significant difference at the 0.001 level (p=0.000), except for the pair comparison between PRT and NST. This implies that these Taiwanese students were highly skilled in written computation but their written skills were not equally transferred to use of non?computational paths that depended on symbolic representation, pictorial representation and number sense to solve similar problems. (shrink)

Ben shu zhu yao yan yong bing zun xun "li shi yu luo ji xiang tong yi" de yuan ze he fang fa, xiang xi shu li, jian tao zuo wei ming dai zhong qi si xiang jia de Huang Wan, qi yi sheng dao xue si xiang jin zhan guo cheng zhong cong Song ru zhi xue (li xue) dao Wang Yangming liang zhi xue (xin xue), zai dao hui gui jing dian (jing xue) de yan bian (...) li cheng, yi qi lun zheng qi xue shu yan bian fan shi zhi yu Ming Qing xue shu zhuan xing de "xian dao xing" dian fan yi yi. (shrink)

The BP neural network model is a hot issue in recent academic research, and it has been successfully applied to many other fields, but few researchers apply the BP neural network model to the field of automobile insurance. The main method that has been used in the prediction of the total claim amount in automobile insurance is the generalized linear model, where the BP neural network model could provide a different approach to estimate the total claim loss. This paper uses (...) a genetic algorithm to optimize the structure of the BP neural network at first, and the calculation speed is significantly improved. At the same time, by considering the overfitting problem, an early stop method is introduced to avoid the overfitting problem. In the model, a three-layer BP neural network model, which includes the input layer, hidden layer, and output layer, is trained. With consideration of various factors, a total claim amount prediction model is established, and the trained BP neural network model is used to predict the total claim amount of automobile insurance based on the data of the training set. The results show that the accuracy of the prediction by using the BP neural network model to both the data of Shandong Province and to the data of six cities is over 95%. Then, the predicted total claim amount is used to calculate premiums for five cities in Shandong Province according to credibility theory. The results show that the average premium of the five cities is slightly higher than the actual claim amount of the city. The combination of BP neural network and credibility theory can perform accurate claim amount estimation and pricing for automobile insurance, which can effectively improve the current situation of the automobile insurance business and promote the development of insurance industry. (shrink)

This study employs an experiment investigating cognitive mapping of fifth-grade children living in a remote village environment, wherein characteristics of the landscape included paths, landmarks, nodes, edges, and districts. Two aspects of analysis were salient in this study. First, important landscape characteristics and their frequency of appearance in the cognitive maps were tabulated and illustrated as a layout map. Second, inaccurate cognitive maps were structurally analyzed to account for any incompleteness, distortions, and augmentation of actual environments found in some map (...) samples. Focus on gender differences in children’s environmental cognition in terms of symbolic representation skills utilized in cognitive mapping is of special interest in this case study. Results confirm Piaget’s theory that older children, aged ten or more, begin to use projective and Euclidean concepts. Furthermore, boys used a greater variety of symbols to represent a particular landscape characteristic, a cultural temple, than did the girls. Finally, we hypothesize that the ‘hunter–gatherer’ social divisions of labor between men and women in the village’s early historical social structure are consequentially related to gender discrepancies in cognitive mapping symbolic representation skills, in non-English-speaking children. (shrink)

Sound-producing movements in percussion performance require a high degree of fine motor control. However, there remains a relatively limited empirical understanding of how performance level abilities develop in percussion performance in general, and marimba performance specifically. To address this issue, nine percussionists performed individualised excerpts on marimba within three testing sessions spaced 29 days apart to assess early, intermediate, and late stages of motor learning. Motor learning was quantified via analyses of both the temporal control of mallet movements, and the (...) spatial variability of upper-limb movements. The results showed that temporal control of mallet movements was greater in the intermediate compared to the early learning session, with no significant additional improvements revealed in the late learning session. In addition, spatial variability in the left and right elbows decreased within the intermediate compared to the early learning session. The results suggest that temporal control of mallet movements may be driven by reductions in spatial variability of elbow movements specifically. As a result, this study provides novel evidence for kinematic mechanisms underlying motor learning in percussion which can be applied towards enhancing musical training. (shrink)

In response to the Covid-19 pandemic, online learning has been carried out in many countries with different types of online learning models being promoted and implemented. In the global pandemic continues, the education environment is forced to change from traditional classroom or blended teaching mode to online learning teaching model. With the outbreak of COVID-19, China was the first to announce that online courses are to be implemented in February 2020. In China, whether online learning can replace traditional offline teaching (...) has become a topic worth discussing. Therefore, this study investigates university students in China by questionnaires and discussions of this topic. The study is based on the Push–Pull Mooring model. Based on 854 valid responses collected from an online survey questionnaire, structural equation modeling was employed to examine the research model. The results show that push effects, pull effects, and mooring effects all significantly influence users' switching intentions from offline to online learning platform. Finally, this study explores whether push–pull–mooring can be a reference for promoting and implementing online learning courses in Chinese colleges and universities in the future after the pandemic. (shrink)

COVID-19 often manifests with different outcomes in different patients, highlighting the complexity of the host-pathogen interactions involved in manifestations of the disease at the molecular and cellular levels. In this paper, we propose a set of postulates and a framework for systematically understanding complex molecular host-pathogen interaction networks. Specifically, we first propose four host-pathogen interaction (HPI) postulates as the basis for understanding molecular and cellular host-pathogen interactions and their relations to disease outcomes. These four postulates cover the evolutionary dispositions involved (...) in HPIs, the dynamic nature of HPI outcomes, roles that HPI components may occupy leading to such outcomes, and HPI checkpoints that are critical for specific disease outcomes. Based on these postulates, an HPI Postulate and Ontology (HPIPO) framework is proposed to apply interoperable ontologies to systematically model and represent various granular details and knowledge within the scope of the HPI postulates, in a way that will support AI-ready data standardization, sharing, integration, and analysis. As a demonstration, the HPI postulates and the HPIPO framework were applied to study COVID-19 with the Coronavirus Infectious Disease Ontology (CIDO), leading to a novel approach to rational design of drug/vaccine cocktails aimed at interrupting processes occurring at critical host-coronavirus interaction checkpoints. Furthermore, the host-coronavirus protein-protein interactions (PPIs) relevant to COVID-19 were predicted and evaluated based on prior knowledge of curated PPIs and domain-domain interactions, and how such studies can be further explored with the HPI postulates and the HPIPO framework is discussed. (shrink)

In his 1927 lecture ‘Phenomenology and Theology’, Heidegger claims that philosophy is the formally indicative ontological co-direction [Mitleitung] of basic theological concepts. For this claim, he...

The COVID-19 pandemic has had a significant impact on education worldwide. The disease first hit China and numerous Chinese cities then started to conduct online courses. Therefore, this study aims to explore the effect of the Shanghai students’ emotional intelligence, learning motivation, and self-efficacy on their academic achievement when they participated in online English classes during the latter phase of the pandemic in China. Furthermore, the research also examines whether the students’ emotional intelligence can influence their academic achievement through the (...) mediation effect of their learning motivation and self-efficacy. Social Cognitive Theory and the social cognitive Expectancy-Value Model were employed to build the research framework, and the method of structural equation modeling was utilized to conduct the model verification. Ten universities in Shanghai, China were selected for sampling. In total, 450 students were surveyed of which 404 questionnaires were valid. The results show that the students’ emotional intelligence did not directly affect their academic achievement. Nevertheless, the students’ emotional intelligence had a positive effect on their learning motivation and self-efficacy. In addition, mediation analysis showed that the relation between emotional intelligence and academic achievement was sequentially mediated by learning motivation and self-efficacy. (shrink)