Obtaining adequate informed consent from trauma patients is challenging and time-consuming. Healthcare providers must communicate complicated medical information to enable patients to make informed decisions. This study aimed to explore the challenges of obtaining valid consent and methods of improving the quality of the informed consent process for surgical procedures in trauma patients. We conducted a systematic review of relevant English-language full-text original articles retrieved from PubMed that had experimental or observational study design and involved adult trauma patients. Studies involving (...) informed consent in clinical or research trials were excluded. Titles and abstracts of searched articles were reviewed and relevant data were extracted with a structured form. Results were synthesized with a narrative approach. A total of 2044 articles were identified in the initial search. Only eight studies were included in the review for narrative synthesis. Six studies involved orthopedic surgeries, one involved nasal bone surgeries, and one involved trauma-related limb debridement. Only one study was conducted in an emergency department. Information recall was poor for trauma patients. Risk recall and comprehension were greater when written or video information was provided than when information was provided only verbally. Patient satisfaction was also greater when both written and verbal information were provided than when verbal information alone was provided; patients who received video information were more satisfied than patients who received written or verbal information. Many articles have been published on the subject of informed consent, but very few of these have focused on trauma patients. More empirical evidence is needed to support the success of informed consent for trauma patients in the emergency department, especially within the necessarily very limited time frame. To improve the informed consent process for trauma patients, developing a structured and standardized informed consent process may be necessary and achievable; its effectiveness would require evaluation. Adequately educating and training healthcare providers to deliver structured, comprehensive information to trauma patients is crucial. Institutions should give top priority to ensuring patient-centered health care and improved quality of care for trauma patients. (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...

Happiness, defined as a state of well-being and contentment, is a central human goal. Despite advances in customer behavior research related to value co-creation, the link between customer happiness and these behaviors remains unclear. This study therefore examines customers’ in-role participation behavior and extra-role citizenship behavior to determine their influence on customers’ happiness. Customer participation and citizenship behaviors relate positively to customers’ perceptions of both service performance and their contributions to others’ welfare. In addition, collectivism moderates the relationship between perceived (...) contributions to others’ welfare and happiness; individualism instead moderates the relationship between perceived service performance and happiness. These findings provide both managerial implications and directions for business marketing ethics. (shrink)

We investigated whether, in the emergency department, educational video-assisted informed consent is superior to the conventional consent process, to inform trauma patients undergoing surgery about the procedure, benefits, risks, alternatives, and postoperative care. We conducted a prospective randomized controlled trial, with superiority study design. All trauma patients scheduled to receive trauma-related debridement surgery in the ED of Kaohsiung Medical University Hospital were included. Patients were assigned to one of two education protocols. Participants in the intervention group watched an educational video (...) illustrating informed consent information, whereas those in the control group read an informed consent document. The primary outcome was knowledge scores and the secondary outcome was assessment of patient satisfaction. A multivariable regression model, with predefined covariates, was used to analyze differences in knowledge scores and patient satisfaction levels between the groups. A total of 142 patients were enrolled, with 70 and 72 assigned to the intervention and control groups, respectively. Mean knowledge scores were higher in the intervention ) than in the control group. By multivariate analysis, the intervention group had significantly greater differences in knowledge scores. Age, injury severity score, and baseline knowledge score significantly affected the differences in knowledge scores. Significant improvements were observed in patients’ perception of statements addressing comprehension of the information provided, helpfulness of the supplied information for decision making, and satisfaction with the informed consent process. Multivariate analysis showed significant correlations between video education and patient satisfaction. Both the educational approach and severity of injury may have an impact on patient understanding during the informed consent process in an emergency environment. Video-assisted informed consent may improve the understanding of surgery and satisfaction with the informed consent process for trauma patients in the ED. Institutions should develop structured methods and other strategies to better inform trauma patients, facilitate treatment decisions, and improve patient satisfaction. The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (shrink)

We proposed a model to examine the relationship among different types of weight-related stigmas and their relationship to quality of life. We recruited 430 dyads of elementary school children [mean age = 10.07 years; nboy = 241 ; noverweight = 138 ] and their parents. Parents completed QoL instruments about their children assessing generic QoL and weight-related QoL. Children completed QoL instruments assessing generic QoL and weight-related QoL and stigma scales assessing experienced weight stigma, weight-related self-stigma, and perceived weight stigma. (...) Experienced weight stigma was significantly associated with perceived weight stigma, and in turn, perceived weight stigma was significantly associated with weight-related self-stigma. However, experienced weight stigma was not directly associated with weight-related self-stigma. In addition, experienced stigma was negatively associated with both child-rated and parent-rated QoL. Perceived weight stigma was associated only with parent-rated weight-related QoL but not child-rated QoL. Self-stigma was associated with child-rated QoL but not parent-rated QoL. Moreover, perceived weight stigma and weight-related self-stigma were significant mediators in the association between body weight and children's QoL; experienced weight stigma was not a significant mediator. The study findings can be used to inform healthcare providers about the relationship among different types of stigmas and their influence on child-rated and parent-rated QoL and help them develop interventions to address the global trend of overweight/obesity in youth and pediatric populations. (shrink)

Background: To evaluate the effectiveness of a multifaceted intervention in improving emergency department (ED) patient privacy and satisfaction in the crowded ED setting. Methods: A pre- and post-intervention study was conducted. A multifaceted intervention was implemented in a university-affiliated hospital ED. The intervention developed strategies to improve ED patient privacy and satisfaction, including redesigning the ED environment, process management, access control, and staff education and training, and encouraging ethics consultation. The effectiveness of the intervention was evaluated using patient surveys. Eligibility (...) data were collected after the intervention and compared to data collected before the intervention. Differences in patient satisfaction and patient perception of privacy were adjusted for predefined covariates using multivariable ordinal logistic regression. Results: Structured questionnaires were collected with 313 ED patients before the intervention and 341 ED patients after the intervention. There were no important covariate differences, except for treatment area, between the two groups. Significant improvements were observed in patient perception of "personal information overheard by others", being "seen by irrelevant persons", having "unintentionally heard inappropriate conversations from healthcare providers", and experiencing "providers' respect for my privacy". There was significant improvement in patient overall perception of privacy and satisfaction. There were statistically significant correlations between the intervention and patient overall perception of privacy and satisfaction on multivariable analysis. Conclusions: Significant improvements were achieved with an intervention. Patients perceived significantly more privacy and satisfaction in ED care after the intervention. We believe that these improvements were the result of major philosophical, administrative, and operational changes aimed at respecting both patient privacy and satisfaction. (shrink)

Ths historical legacy inherited by thinkers of the Ch'un-ch'iu period comprised, briefly speaking: a religious world outlook characterized by ancestor worship; the ethical concept of filial piety and brotherliness, which was linked to ancestor worship, or derived therefrom; the concept of a ritual system; the conditions of aristocratic politics and scholar bureaucracy. These were things shaped on the basis of the blood ties in a patriarchal and racial society, and they were passive, from the standpoint of progress, being the obstacle (...) that hindered people from making big strides forward. Next, there were the tendency toward simple materialism and dialectics, which was born from the bowels of religious world outlook; the materialist philosophy of complaint against and hatred and cursing of Heaven; the belief in things and in laws; and Shih Po's doctrine of "Things are produced when matter combines." These were positive things, especially the last three, which emerged at a time when the slave system had begun to collapse, and which formed the premise of their ideological advance. Who among the thinkers of the Ch'un-ch'iu period would inherit and develop these things, what questions would be raised, probed, discussed, or argued on the common basis of their traditional thought, and what specific forms would be used to answer these questions had to be determined by their class stand and by the characteristics of the period in which they lived. (shrink)

The philosophical thought of the Ch'un-ch'iu period was derived and developed from the thought of the Yin dynasty and the Western Chou , there being an inseparable relationship of succession and transformation between them. Thus, in studying the philosophical thought of the Ch'un-ch'iu period, it is necessary to refer back to Yin-Chou thought. The courage and resolve evidenced by an attitude of so-called "cutting off the miscellaneous streams" in order to start with Lao Tzu or Confucius is really a very (...) awkward way of dissecting history. (shrink)

This paper proposes extending the appearance of artefacts from human to zoomorphic on the basis of the uncanny valley phenomenon, while simultaneously realising the effects of bionic species, product realism, and gender differences on preschool children’s preferences for artificial animal appearances. In this study, animal toys were created as stimuli and a three-factor experiment was conducted with preschool children. Overall, the children demonstrated significantly stronger preferences for animal toys with extremely high or moderate realism compared with those with extremely low (...) realism. Specifically, the boys preferred the toys with extremely high realism, and the girls preferred those with moderate realism. We conclude with some suggestions regarding the direction of design guidelines for the appearance of artificial animals, to facilitate the design and creation of animal products that promote human–robot interactions and design education. (shrink)

Given the widespread acceptance of computational thinking in educational systems around the world, primary and higher education has begun thinking about how to cultivate students' CT competences. The artificial intelligence of things combines artificial intelligence and the Internet of things and involves integrating sensing technologies at the lowest level with relevant algorithms in order to solve real-world problems. Thus, it has now become a popular technological application for CT training. In this study, a novel AIoT learning with Augmented Reality technology (...) was proposed and explored the effect of CT skills. The students used AR applications to understand AIoT applications in practice, attempted the placement of different AR sensors in actual scenarios, and further generalized and designed algorithms. Based on the results of the experimental course, we explored the influence of prior knowledge and usage intention on students' CT competence training. The results show that proposed AIoT learning can increase students' learning intention and that they had a positive impact on problem solving and comprehension with AR technology, as well as application planning and design. (shrink)

We show that as game theory was transferred from mathematical oncology to experimental cancer biology, a new mode of inquiry was created. Modeling was replaced by measuring. The game measured by a game assay can serve as a bridge that allows knowledge to flow backward from target (cancer research) to source (game theory). Our finding suggests that the conformist and creative (Houkes and Zwart 2019) types of transfer need to be augmented. We conclude by introducing the expansive and transformative types (...) to get a four-tier typology of knowledge transfer. (shrink)

Mathematical models and their modeling frameworks developed to advance knowledge in one discipline are sometimes sourced to answer questions or solve problems in another discipline. Studying this aspect of cross-disciplinary transfer of knowledge objects, philosophers of science have weighed in on the question of whether knowledge about how a mathematical model is previously applied in one discipline is necessary for the success of reapplying said model in a different discipline. However, not much has been said about whether the answer to (...) that epistemological question applies to the reapplication of a modeling framework. More generally, regarding the nature of the production of knowledge in science, a metaphysical question remains to be explored whether historical contingencies associated with a mathematical construct have a genuine impact on the nature—as opposed to sociological practices or individual psychology—of advancing scientific knowledge with said construct. Focusing on this metaphysical question, this paper analyzes the use of mathematical logic in the development of the Chomsky hierarchy and subsequent reapplications of said hierarchy; with these examples, this paper develops the notion of “spillovers” as a way to detect cross-disciplinary justifications for better understanding the relations between reapplications of the same mathematical construct across disciplines. (shrink)

Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients’ knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items to forecast (...) outcomes was applied to reach a consensus among the experts. The resulting consensus was used to develop the video content and questions for measuring the understanding of the informed consent for debridement surgery in limb trauma patients. The expert panel included experienced patients. The participants in this pilot study were enrolled as a convenience sample of adult trauma patients scheduled to receive surgery. The modified Delphi technique comprised three rounds over a 4-month period. The items given higher scores by the experts in several categories were chosen for the subsequent rounds until consensus was reached. The experts reached a consensus on each item after the three-round process. The final knowledge measure comprising 10 questions was developed and validated. Thirty eligible trauma patients presenting to the Emergency Department were approached and completed the questionnaires in this pilot study. The participants exhibited significantly higher mean knowledge and satisfaction scores after watching the educational video than before watching the video. Our process is promising for developing procedure-specific informed consent and audiovisual aids in medical and surgical specialties. The educational video was developed using a scientific method that integrated the opinions of different stakeholders, particularly patients. This video is a useful tool for improving the knowledge and satisfaction of trauma patients in the ED. The modified Delphi technique is an effective method for collecting experts’ opinions and reaching a consensus on the content of educational materials for informed consent. Institutions should prioritize patient-centered health care and develop a structured informed consent process to improve the quality of care. The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (shrink)

Background Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients’ knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. Methods A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items (...) to forecast outcomes was applied to reach a consensus among the experts. The resulting consensus was used to develop the video content and questions for measuring the understanding of the informed consent for debridement surgery in limb trauma patients. The expert panel included experienced patients. The participants in this pilot study were enrolled as a convenience sample of adult trauma patients scheduled to receive surgery. Results The modified Delphi technique comprised three rounds over a 4-month period. The items given higher scores by the experts in several categories were chosen for the subsequent rounds until consensus was reached. The experts reached a consensus on each item after the three-round process. The final knowledge measure comprising 10 questions was developed and validated. Thirty eligible trauma patients presenting to the Emergency Department were approached and completed the questionnaires in this pilot study. The participants exhibited significantly higher mean knowledge and satisfaction scores after watching the educational video than before watching the video. Conclusions Our process is promising for developing procedure-specific informed consent and audiovisual aids in medical and surgical specialties. The educational video was developed using a scientific method that integrated the opinions of different stakeholders, particularly patients. This video is a useful tool for improving the knowledge and satisfaction of trauma patients in the ED. The modified Delphi technique is an effective method for collecting experts’ opinions and reaching a consensus on the content of educational materials for informed consent. Institutions should prioritize patient-centered health care and develop a structured informed consent process to improve the quality of care. Trial registration The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (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)

This study explored the effect of learning strategies in a student organization on cake art creativity. The participants were 27 student members of a cake decorating art club from one central university in Taiwan. A quasi-experimental pretest-posttest design was adopted, with 90 h of experimental teaching over 16 weeks. The results, which included the use of a questionnaire, classroom observation, and in-depth interviews, suggest that in terms of creativity, the group participating in flipped classroom learning significantly outperformed the group using (...) traditional learning strategies. Furthermore, flipped classroom learning promoted learner motivation and satisfaction. (shrink)

Is the societal-level of analysis sufficient today to understand the values of those in the global workforce? Or are individual-level analyses more appropriate for assessing the influence of values on ethical behaviors across country workforces? Using multi-level analyses for a 48-society sample, we test the utility of both the societal-level and individual-level dimensions of collectivism and individualism values for predicting ethical behaviors of business professionals. Our values-based behavioral analysis indicates that values at the individual-level make a more significant contribution to (...) explaining variance in ethical behaviors than do values at the societal-level. Implicitly, our findings question the soundness of using societal-level values measures. Implications for international business research are discussed. (shrink)

This chapter discusses the use of formal language theory in the investigation of diverse phenomena such as natural languages, computer code, and animal cognition. Formal language theory deals with mathematically defined languages as well as the formal systems, such as grammars and automata, that are used to define them. In this context, a language is a set of strings, a grammar specifies a set of rules for forming the string-set from an alphabet, and an automaton is an abstract machine that (...) can be programmed to generate or recognize a formal language. Formal language theory can thus be understood as the study of string-sets and their associated formal systems. As a result of being used as a model template across linguistics, computer science, and experimental cognitive science, formal systems in formal language theory, as well as a classification scheme called the Chomsky hierarchy, are given different interpretations. (shrink)

Mathematical formalisms that are constructed for inquiry in one disciplinary context are sometimes applied to another, a phenomenon that I call ‘tool migration.’ Philosophers of science have addressed the advantages of using migrated tools. In this paper, I argue that tool migration can be epistemically risky. I then develop an analytic framework for better understanding the risks that are implicit in tool migration. My approach shows that viewing mathematical constructs as tools while also acknowledging their representational features allows for a (...) balanced understanding of knowledge production that is aided by the research tools migrated across disciplinary boundaries. (shrink)

Vampire stories and folklores have originated from a range of sources; however, it is rather certain that the repulsive but attractive vampiric monster images in present popular culture are primarily derived from Anne Rice’s novel Interview with the Vampire. That being said, it was around the end of the eighteenth century that vampires first invaded the popular literary world, with literary vampires growing noticeably more powerful and perpetual than any of their monstrous predecessors in the years since the publication of (...) John Polidori’s successful short story The Vampyre in 1819. Due to associated aesthetic transformations, vampirism itself has become increasingly popular, to the extent that it now commands some followers who even worship vampiric rituals and lifestyles in spite of there being no solid, physical evidence of actual vampires, but rather only literary and imaginary examples of the creatures. In order to grasp how this fascination with vampires has turned into a quasi-religious phenomenon and ideology, a proper investigation of vampiric mechanisms and aesthetics should be empirical in nature. Utilizing Interview with the Vampire as an example due to its clearly substantial influence on current vampire imagery, this article examines how the paradoxical interchange between aversion and attraction plays its role in the visceral religion of the vampire-immersed world. (shrink)

This article provides current Schwartz Values Survey (SVS) data from samples of business managers and professionals across 50 societies that are culturally and socioeconomically diverse. We report the society scores for SVS values dimensions for both individual- and societal-level analyses. At the individual-level, we report on the ten circumplex values sub-dimensions and two sets of values dimensions (collectivism and individualism; openness to change, conservation, self-enhancement, and self-transcendence). At the societal-level, we report on the values dimensions of embeddedness, hierarchy, mastery, affective (...) autonomy, intellectual autonomy, egalitarianism, and harmony. For each society, we report the Cronbach’s α statistics for each values dimension scale to assess their internal consistency (reliability) as well as report interrater agreement (IRA) analyses to assess the acceptability of using aggregated individual level values scores to represent country values. We also examined whether societal development level is related to systematic variation in the measurement and importance of values. Thus, the contributions of our evaluation of the SVS values dimensions are two-fold. First, we identify the SVS dimensions that have cross-culturally internally reliable structures and within-society agreement for business professionals. Second, we report the society cultural values scores developed from the twenty-first century data that can be used as macro-level predictors in multilevel and single-level international business research. (shrink)

Body ownership concerns what it is like to feel a body part or a full body as mine, and has become a prominent area of study. We propose that there is a closely related type of bodily self-consciousness largely neglected by researchers—experiential ownership. It refers to the sense that I am the one who is having a conscious experience. Are body ownership and experiential ownership actually the same phenomenon or are they genuinely different? In our experiments, the participant watched a (...) rubber hand or someone else’s body from the first-person perspective and was touched either synchronously or asynchronously. The main findings: (1) The sense of body ownership was hindered in the asynchronous conditions of both the body-part and the full-body experiments. However, a strong sense of experiential ownership was observed in those conditions. (2) We found the opposite when the participants’ responses were measured after tactile stimulations had ceased for 5 s. In the synchronous conditions of another set of body-part and full-body experiments, only experiential ownership was blocked but not body ownership. These results demonstrate for the first time the double dissociation between body ownership and experiential ownership. Experiential ownership is indeed a distinct type of bodily self-consciousness. (shrink)

Objectives: The N2b is an event-related potential component thought to index higher-order executive function. While the impact of concussion on executive functioning is frequently discussed in the literature, limited research has been done on the role of N2b in evaluating executive functioning in patients with concussion. The aims of this review are to consolidate an understanding of the cognitive functions reflected by the N2b and to account for discrepancies in literature findings regarding the N2b and concussion.Methods: A scoping review was (...) conducted on studies that used the N2b to measure cognitive functioning in healthy control populations, as well as in people with concussions.Results: Sixty-six articles that met inclusion criteria demonstrated that the N2b effectively represents stimulus-response conflict management, response selection, and response inhibition. However, the 19 included articles investigating head injury found widely varied results: some studies found the amplitude of the N2b to be increased in the concussion group, while others found it to be decreased or unchanged.Conclusion: Based on the available evidence, differences in the amplitude of the N2b have been linked to response selection, conflict, and inhibition deficits in concussion. However, due to large variations in methodology across studies, findings about the directionality of this effect remain inconclusive. The results of this review suggest that future research should be conducted with greater standardization and consistency. (shrink)

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)

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)