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)

Mencius, a prominent Confucian philosopher in the Warring States period of ancient China, is well-known for his argumentative skills, including his refutational skills used to maintain his own standpoints. This paper attempts to reveal how Mencius refuted his opponents argumentatively and strategically on the issue of human nature. To this end, the pragma-dialectical approach to argumentation is adopted to first reconstruct Mencius’s argumentative discourse on human nature according to the four stages in critical discussion—the confrontation, opening, argumentation and concluding stages. (...) Under the ancient Chinese historical and cultural context, Mencius’s argumentative discourse about human nature was developed in three critical discussions, between Mencius the protagonist, and his explicit interlocutors and implicit adversaries who held different views on human nature—the antagonists. The discussions were undertaken around three single mixed differences of opinion concerning three propositions, with resolution of the first difference of opinion serving as a starting point of the second, and the resolution of the second as a starting point of the third. Then based on the reconstruction, the paper elaborates the refutational strategies that Mencius employed in various stages, such as dissociation, reductio ad absurdum based on refutational analogy, and conciliation. It further points out that the employment of these strategies is strategic maneuvering undertaken by Mencius in an attempt to realize both dialectical and rhetorical aims. (shrink)

Through users’ cross-system comparative experience engaging with the health systems in Taiwan and other countries, this article probes into their understandings and value judgments and specifically their reasonings for the ‘solidarity with whom?’ question in the health sector solidarity. With the cross-system comparison approach, the study adopted semi-structured interviews with 30 Taiwanese participants who have studied, lived or worked abroad and engaged with the health system in Canada, the USA or the UK. This approach offers the opportunity for one to (...) evaluate the health system in the home country from a relative viewpoint from the host country. The participants suggested that the boundary of Taiwan’s National Health Insurance (NHI) should be as inclusive as possible, covering all legal residents in Taiwan regardless of their status, and that the citizens should share more financial responsibility. The ethical reasons for supporting the NHI include recognizing health sector solidarity among people, considering the coverage as a protection of the human right to health, humanitarian reasons and self-interest. Three archetypes of users emerged from the synthesis: Universalists, Rationalists and Republicans. The cross-system comparative experience makes the participants have more supportive attitudes toward the ideals of health sector solidarity. (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)

This paper proposes a constrained solution update strategy for multiobjective evolutionary algorithm based on decomposition, in which each agent aims to optimize one decomposed subproblem. Different from the existing approaches that assign one solution to each agent, our approach allocates the closest solutions to each agent and thus the number of solutions in an agent may be zero and no less than one. Regarding the agent with no solution, it will be assigned one solution in priority, once offspring are generated (...) closest to its subproblem. To keep the same population size, the agent with the largest number of solutions will remove one solution showing the worst convergence. This improves diversity for one agent, while the convergence of other agents is not lowered. On the agent with no less than one solution, offspring assigned to this agent are only allowed to update its original solutions. Thus, the convergence of this agent is enhanced, while the diversity of other agents will not be affected. After a period of evolution, our approach may gradually reach a stable status for solution assignment; i.e., each agent is only assigned with one solution. When compared to six competitive multiobjective evolutionary algorithms with different population selection or update strategies, the experiments validated the advantages of our approach on tackling two sets of test problems. (shrink)

This study aims to investigate the moderating effect of the board chair's role on the relationship between board human capital and firm performance. Board human capital has been regarded as a valuable asset that enhances firm performance. Especially, the board chair plays a crucial role in developing this high-echelon human capital. This study utilises a set of longitudinal data to examine 275 firms in Taiwan. The result indicates that board human capital is positively related to firm performance, and the individual (...) human capital of the board chair represents a moderating effect on the relationship between board human capital and performance. (shrink)

Both glycemic control and handgrip strength affect microvascular function. Multiscale entropy of photoplethysmographic pulse amplitudes may differ by diabetes status and hand activity. Of a middle-to-old aged and right-handed cohort without clinical cardiovascular disease, we controlled age, sex, and weight to select the unaffected,the well-controlled diabetes, and the poorly controlled diabetes groups. MSEs were calculated from consecutive 1,500 PPG pulse amplitudes of bilateral index fingertips. Thesmall-, medium-,and large-scale MSEs were defined as the average of scale 1, scales 2–4, and scales (...) 5–10, respectively. Intra- and intergroups were compared by one- and two-samplet-tests, respectively. The dominant handMSE5–10was lower in the poorly controlled diabetes group than the well-controlled diabetes and the unaffected groups, whereas the nondominant handMSE5–10was lower in the well- and poorly controlled diabetes groups than the unaffected group. TheMSE1of dominant hand was higher than that of nondominant hand in the well-controlled diabetes. In conclusion, diabetes status and hand dominance may affect the MSE of PPG pulse amplitudes. (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)

Understanding the neural basis of schizophrenia (SZ) is important for shedding light on the neurobiological mechanisms underlying this mental disorder. Structural and functional alterations in the anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (DLPFC), hippocampus, and medial prefrontal cortex (MPFC) have been implicated in the neurobiology of SZ. However, the effective connectivity among them in SZ remains unclear. The current study investigated how neuronal pathways involving these regions were affected in first-episode SZ using functional magnetic resonance imaging (fMRI). Forty-nine patients (...) with a first-episode of psychosis and diagnosis of SZ—according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision—were studied. Fifty healthy controls (HCs) were included for comparison. All subjects underwent resting state fMRI. We used spectral dynamic causal modeling (DCM) to estimate directed connections among the bilateral ACC, DLPFC, hippocampus, and MPFC. We characterized the differences using Bayesian parameter averaging (BPA) in addition to classical inference (t-test). In addition to common effective connectivity in these two groups, HCs displayed widespread significant connections predominantly involved in ACC not detected in SZ patients, but SZ showed few connections. Based on BPA results, SZ patients exhibited anterior cingulate cortico-prefrontal-hippocampal hyperconnectivity, as well as ACC-related and hippocampal-dorsolateral prefrontal-medial prefrontal hypoconnectivity. In summary, spectral DCM revealed the pattern of effective connectivity involving ACC in patients with first-episode SZ. This study provides a potential link between SZ and dysfunction of ACC, creating an ideal situation to associate mechanisms behind SZ with aberrant connectivity among these cognition and emotion-related regions. (shrink)

Lifelong premature ejaculation (LPE) is a common male sexual dysfunction. Lack of active control for rapid ejaculation brought great distress to sexual harmony, and even fertility. Previous neurophysiology studies revealed an ejaculation-related control mechanism in the brain. However, it remains unclear whether this inhibitory network is altered in LPE patients. The present study investigated the central inhibitory network function of LPE patients by using stop signal task-related functional magnetic resonance imaging and resting-state functional connectivity analysis. The results showed no difference (...) in task-related behavioral performance or neural activation during response inhibition between LPE patients and controls. However, LPE patients showed a significantly different correlation pattern between the stop signal reaction time (SSRT) and left inferior frontal gyrus activation during successful inhibition, in which a typical negative correlation between SSRT and the activation was completely disappeared in patients. In addition, using the left inferior frontal gyrus as a seed, patients showed weaker functional connectivity between the seed and two areas (left dental nucleus and right frontal pole) compared with controls. These data suggest that LPE patients have an abnormal brain control network, which may contribute to the reduced central control of rapid ejaculation. This study provides new insights into the neural mechanism of LPE involving the central inhibitory network, which may offer an underlying intervention target for future treatment. (shrink)

The meshed control theory assumes that cognitive control and automatic processes work together in the natural attention of experts for superior performance. However, the methods adopted by previous studies limit their capacity to provide in-depth information on the neuromotor processes. This experiment tested the theory with an alternative approach. Twelve skilled golfers were recruited to perform a putting task under three conditions: (1) normal condition, with no focus instruction (NC), (2) external focus of attention condition (EC), and (3) internal focus (...) of attention condition (IC). Four blocks of 10 putts each were performed under each condition. The putting success rate and accuracy were measured and electroencephalographies (EEGs) were recorded. The behavioral results showed that the NC produced a higher putting success rate and accuracy than the EC and IC. The EEG data showed that the skilled golfers’ attentional processes in the NC initially resembled those in the EC and then moved toward those in the IC just before putting. This indicates a switch from more automatic processes to cognitive control processes while preparing to putt. The findings offer support for the meshed control theory and indicate the dynamic nature of neuromotor processes for the superior performance of athletes in challenging situations. (shrink)

The question of what determines brain laterality for auditory cognitive processing is unresolved. Here, we demonstrate a swap of hemisphere dominance from right to left during semantic interpretation of Chinese lexical tones in native speakers using simultaneously recorded mismatch negativity response and behavioral reaction time during dichotic listening judgment. The mismatch negativity, which is a brain wave response and indexes auditory processing at an early stage, indicated right hemisphere dominance. In contrast, the behavioral reaction time, which reflects auditory processing at (...) a later stage, indicated a right ear listening advantage, or left hemisphere dominance. The observed swap of hemisphere dominance would not occur when the lexical tone was substituted with a meaningless pure tone. This swap reveals dependence of hemisphere labor division initially on acoustic and then on functional cues of auditory inputs in the processing from sound to meaning. (shrink)

This paper uses WIOD data to calculate and analyze the dominant comparative advantage of Chinese manufacturing global value chain based on the WWZ method and empirically studies the influence of digitization on the competitiveness of manufacturing GVC. The main findings are as follows: The competitiveness of Chinese manufacturing GVC has been improved as a whole. The GVC competitiveness of different types of industries is quite different: GVC in middle- and low-knowledge-intensive industries have the highest competitiveness, while those with middle- and (...) high-knowledge-intensive industries have the lowest competitiveness and apparent shortboard industries. Digitization is conducive for enhancing the competitiveness of manufacturing GVC. In terms of industries, digitization has a significant positive effect on the GVC competitiveness of middle and high-knowledge-intensive industries but not on low knowledge ones. As for the sources of digital input, the positive effect is more outstanding. Also, it is more remarkable when it comes to the software and information technology service industry. As for the mechanism of action, labor productivity is an effective way to improve the manufacturing GVC competitiveness digitally. Finally, after a robustness test, the positive effect of the digital input remains robust. (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)

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)

In recent years, due to factors such as rising sea levels, several island nations such as Maldives, Tuvalu, Kiribati, and the Marshall Islands are in danger of disappearing completely. When the land of an island country disappeared, the human rights protection of Environmentally Displaced Persons in the migration process and the possible loss of their unique culture, language, and lifestyle have aroused great concern. We call such Environmentally Displaced Persons as EDPs. This study selects the EDPs’ data of 241 countries (...) or regions from 2008 to 2018, establishes an ARIMA model, and predicts the future population of EDPs. By combining the influencing factors of cultural loss, the risk assessment model of cultural loss is established to evaluate the possibility of cultural loss during the migration process of EDPs. We have established a Bayesian Network and a Fault Tree Model to demonstrate the improvement brought about by the implementation of policy recommendations from both qualitative and quantitative perspectives and use the method of fault tree analysis to illustrate the importance of policies from the degree of probability reduction after policy changes. Finally, based on the above model establishment and data analysis, corresponding countermeasures are proposed to protect EDPs’ human rights from being violated and their culture will not be lost. (shrink)

An interesting phenomenon called “hidden opportunity cost of time effect” was detected in intertemporal choices. The majority of our participants preferred the smaller but sooner (SS) option to the larger but later (LL) option if opportunity cost was explicit. However, a higher proportion of participants preferred the LL to SS option if opportunity cost was hidden. This shift violates the invariance principle and opens a new way to encourage future-oriented behavior. By simply mentioning the ‘obvious’ opportunity cost of alternatives, decision (...) makers can be more informed in prioritizing their long-term goals rather than short-term goals. (shrink)

BackgroundBoosting the individual learning passion of medical students is a novel approach to improve their academic performance. It facilitates the medical education reform, motivating both policymakers and educators to focus on the function of positive psychology in the career development of medical students. Therefore, this study aimed to assess the status of two types of learning passion; to clarify the relationship between self-esteem and two types of learning passion among Chinese medical students; to examine the mediating role of psychological capital (...) in the relationship between self-esteem and two types of learning passion, respectively; and to identify the moderating role of professional identity in the relationship between PsyCap and two types of learning passion, respectively.MethodsA cross-sectional online survey was conducted from April to June 2016 in China. A total of 1,218 valid questionnaires were collected from four medical schools.ResultsSelf-esteem significantly and positively influenced medical students’ PsyCap.ConclusionTwo types of learning passion of medical students are positively influenced by self-esteem and PsyCap. Medical students with high-level self-esteem should possess strong PsyCap, which augments their harmonious as well as obsessive learning passion. Moreover, the positive effect of medical students’ PsyCap on harmonious learning passion is more notable among those with a lower professional identity. Finally, this study argues that strengths-based interventions of self-esteem and PsyCap are a beneficial approach for future enhancing learning passion in the domain of medical education. (shrink)