Objectives: To investigate the current situation of completing the informed consent for do-not-resuscitate (DNR) orders among the competent patients with terminal illness and the ethical dilemmas related to it. Participants: This study enrolled 152 competent patients with terminal cancer, who were involved in the initial consultations for hospice care. Analysis: Comparisons of means, analyses of variance, Student’s t test, χ2 test and multiple logistic regression models. Results: After the consultations, 117 (77.0%) of the 152 patients provided informed consent for hospice (...) care and DNR orders. These included 21 patients (17.9%) who signed the consent by themselves, and 96 (82.1%) whose consent sheet was signed only by family members. The reasons why patients were not involved in the discussions toward the consent (n = 82) included poor physical or psychological condition (44.9%), concerns of the consultant hospice team (37.2%), and the family’s refusal (28.2%). On a multivariate analysis, patients’ awareness of their poor prognosis (odds ratio = 4.07, 95% confidence interval = 2.05 to 8.07) and their understanding of hospice care (2.27, 1.33 to 3.89) were two independent factors (p<0.01) that influenced their participation in the discussions or their personal signature in the informed consent. Conclusion: The family-oriented culture in Asian countries may violate the principles of the Patient Self-Determination Act and the requirements of the Hospice Care Law in Taiwan, which inevitably poses an ethical dilemma. Earlier truth-telling and continuing education of the public by hospice care workers will be helpful in solving such ethical dilemmas. (shrink)

Recent research has shown that mind wandering recruits executive resources away from the external task towards inner thoughts. No studies however have determined whether executive functions are drawn away in a unitary manner during mind wandering episodes, or whether there is variation in specific functions impacted. Accordingly, we examined whether mind wandering differentially modulates three core executive functions—response inhibition, updating of working memory, and mental set shifting. In three experiments, participants performed one of these three executive function tasks and reported (...) their attentional state as either on-task or mind wandering at random intervals. We found that mind wandering led to poorer performance in the response inhibition and working memory tasks, but not the set-shifting task. These findings suggest that mind wandering does not recruit executive functions in a monolithic manner. Rather, it appears to selectively engage certain executive functions, which may reflect the adaptive maintenance of ongoing task performance. (shrink)

A recent series of experiments have demonstrated that a classical fluid mechanical system, constituted by an oil droplet bouncing on a vibrating fluid surface, can be induced to display a number of behaviours previously considered to be distinctly quantum. To explain this correspondence it has been suggested that the fluid mechanical system provides a single-particle classical model of de Broglie’s idiosyncratic ‘double solution’ pilot wave theory of quantum mechanics. In this paper we assess the epistemic function of the bouncing oil (...) droplet experiments in relation to quantum mechanics. We find that the bouncing oil droplets are best conceived as an analogue illustration of quantum phenomena, rather than an analogue simulation, and, furthermore, that their epistemic value should be understood in terms of how-possibly explanation, rather than confirmation. Analogue illustration, unlike analogue simulation, is not a form of ‘material surrogacy’, in which source empirical phenomena in a system of one kind can be understood as ‘standing in for’ target phenomena in a system of another kind. Rather, analogue illustration leverages a correspondence between certain empirical phenomena displayed by a source system and aspects of the ontology of a target system. On the one hand, this limits the potential inferential power of analogue illustrations, but, on the other, it widens their potential inferential scope. In particular, through analogue illustration we can learn, in the sense of gaining how-possibly understanding, about the putative ontology of a target system via an experiment. As such, the potential scientific value of these extraordinary experiments is undoubtedly a significant one. (shrink)

A complement clause is used instead of a noun phrase; for example one can say either I heard [the result] or I heard [that England beat France]. Languages differ in the grammatical properties of complement clauses, and the types of verbs which take them. Some languages lack a complement clause construction but instead employ other construction types to achieve similar ends; these are called complementation strategies. The book explores the variety of types of complementation found across the languages of the (...) world, their grammatical properties and meanings. Detailed studies of particular languages, including Akkadian, Israeli, Jarawara, and Pennsylvania German, are framed by R. M. W. Dixon's introduction, which sets out the range of issues, and his conclusion, which draws together the evidence and the arguments. This book will interest scholars of typology, language universals, syntax, information structure, and language contact in departments of linguistics and anthropology, as well as advanced and graduate students taking courses in these subjects. (shrink)

Discourse particles have received a considerable amount of scholarly attention in linguistic research. Although their use in specific text types has been discussed, few studies have actually attempted to look at the effect of text type on their use. Therefore, how the use of discourse particles is related to the situational context in which they are produced remains a largely unexplored area. In this article, the use of one of the most frequently occurring yet often overlooked discourse particles, so, in (...) a number of monologic and dialogic texts is examined. Drawing on data from a spoken corpus of Hong Kong English, the present study shows that the frequency rates and functions of so as a discourse particle vary according to the text type in which it occurs. Findings from the study thus argue that the full range of functions realized by so as a discourse particle cannot be determined without taking into account the wide range of communicative events in which the particle is used. This highlights the fact that contextual cues are indispensable in the interpretation of the pragmatic meanings of discourse particles. (shrink)

Although the same environmental regulations apply to all regions in China, legal enforcement can be different due to local economic development priorities. There is still a lack of knowledge about how regional disparities affect the operating performance results of the implementation of corporate environmental management practices, thus providing little information for foreign companies when they invest and develop their production base in China. To fill this research gap, this paper collects data from the Fortune 500 Chinese firms to investigate the (...) moderating role of regional disparities in affecting the performance results of corporate environmental management efforts based on the institutional theory. The disclosed corporate environmental responsibility practices serve as proxy to represent corporate environmental management practices. Content analysis approach was applied to collect and analyze CER practices published in the corporate reports of Chinese manufacturers. The results show that CER has a positive impact on operating income, while regional disparities influence the relationship between CER and corporate operating income. Specifically, CER and operating income are positively related in Eastern China; on the contrary, they are negatively related in Western China. This paper adds to the body of knowledge about environmental discrepancies in the same emerging economy, and provides insights for systematic consideration in terms of the issues of government environmental regulations and corporate environmental strategies. (shrink)

BackgroundBreast cancer patients are at elevated risk of depression during treatment, thus provoking the chance of poor clinical outcomes. This retrospective cohort study aimed to investigate whether integrating Chinese herbal medicines citation into conventional cancer therapy could decrease the risk of depression in the long-term breast cancer survivors.MethodsA cohort of patients aged 20–70 years and with newly diagnosed breast cancer during 2000–2008 was identified from a nationwide claims database. In this study, we focused solely on survivors of breast cancer at (...) least1 year after diagnosis. After one-to-one matching for age, sex, and baseline comorbidities, breast cancer patients who received and did not receive CHM treatment were enrolled. The incidence rate and hazard ratio citation for depression between the two groups was estimated at the end of 2012. A Cox proportional hazard model was constructed to examine the impact of the CHM use on the risk of depression.ResultsDuring the study period, the incidence rate of depression was significantly lower in the treated cohort than in the untreated cohort [8.57 compared with 11.01 per 1,000 person-years citation], and the adjusted HR remained significant at 0.74 in a Cox proportional hazards regression model. The corresponding risk further decreasing to 43% among those using CHM for more than 1 year.ConclusionFinding from this investigation indicated that the lower risk of depression observed in breast cancer patients treated with CHM, suggesting that CHM treatment should be considered for disease management toward breast cancer. Yet, the optimal administered dose should be determined in further clinical trials. (shrink)

Stress is one of the most powerful experiences to influence health and disease. Through epigenetic mechanisms, stress may generate a footprint that propagates to subsequent generations. Programming by prenatal stress or adverse experience in parents, grandparents, or earlier generations may thus be a critical determinant of lifetime health trajectories. Changes in regulation of microRNAs (miRNAs) by stress may enhance the vulnerability to certain pathogenic factors. This review explores the hypothesis that miRNAs represent stress‐responsive elements in epigenetic regulation that are potentially (...) heritable. Recent findings suggest that miRNAs are key players linking adverse early environments or ancestral stress with disease risk, thus they represent useful predictive disease biomarkers. Since miRNA signatures of disease are potentially heritable, big data management platforms will be vital to harness multi‐generational information and capture succinct yet potent biomarkers capable of directing preventative treatments. This feature would offer a unique window of opportunity to advance personalized medicine. (shrink)

Peter Abelard (1079–1142 ce) was the most wide‐ranging philosopher of the twelfth century. He quickly established himself as a leading teacher of logic in and near Paris shortly after 1100. After his affair with Heloise, and his subsequent castration, Abelard became a monk, but he returned to teaching in the Paris schools until 1140, when his work was condemned by a Church Council at Sens. His logical writings were based around discussion of the “Old Logic”: Porphyry's Isagoge, aristotle'S Categories and (...) On Interpretation and boethius'S textbook on topical inference. They comprise a freestanding Dialectica (“Logic”; probably c.1116), a set of commentaries (known as the Logica [Ingredientibus], c. 1119) and a later (c. 1125) commentary on the Isagoge (Logica Nostrorum Petititoni Sociorum or Glossulae). In a work Abelard called his Theologia, issued in three main versions (between 1120 and c.1134), he attempted a logical analysis of trinitarian relations and explored the philosophical problems surrounding God's claims to omnipotence and omniscience. The Collationes (“Debates,” also known as “Dialogue between a Christian, a Philosopher and a Jew”; probably c.1130) present a rational investigation into the nature of the highest good, in which the Christian and the Philosopher (who seems to be modeled on a philosopher of pagan antiquity) are remarkably in agreement. The unfinished Scito teipsum (“Know thyself,” also known as the “Ethics”; c.1138) analyses moral action. (shrink)

Neonatal brain monitoring in the neonatal intensive care units (NICU) requires a continuous review of the spontaneous cortical activity, i.e., the electroencephalograph (EEG) background activity. This needs development of bedside methods for an automated assessment of the EEG background activity. In this paper, we present development of the key components of a neonatal EEG background classifier, starting from the visual background scoring to classifier design, and finally to possible bedside visualization of the classifier results. A dataset with 13,200 5-minute EEG (...) epochs (8–16 channels) from 27 infants with birth asphyxia was used for classifier training after scoring by two independent experts. We tested three classifier designs based on 98 computational features, and their performance was assessed with respect to scoring system, pre- and post-processing of labels and outputs, choice of channels, and visualization in monitor displays. The optimal solution achieved an overall classification accuracy of 97% with a range across subjects of 81–100%. We identified a set of 23 features that make the classifier highly robust to the choice of channels and missing data due to artefact rejection. Our results showed that an automated bedside classifier of EEG background is achievable, and we publish the full classifier algorithm to allow further clinical replication and validation studies. (shrink)

Let ≤r and ≤sbe two binary relations on 2ℕ which are meant as reducibilities. Let both relations be closed under finite variation and consider the uniform distribution on 2ℕ, which is obtained by choosing elements of 2ℕ by independent tosses of a fair coin.Then we might ask for the probability that the lower ≤r-cone of a randomly chosen set X, that is, the class of all sets A with A ≤rX, differs from the lower ≤s-cone of X. By c osure (...) under finite variation, the Kolmogorov 0-1 aw yields immediately that this probability is either 0 or 1; in case it is 1, the relations are said to be separable by random oracles.Again by closure under finite variation, for every given set A, the probability that a randomly chosen set X is in the upper ≤r-cone of A is either 0 or 1; let Almostr be the class of sets for which the upper ≤r-cone has measure 1. In the following, results about separations by random oracles and about Almost classes are obtained in the context of generalized reducibilities, that is, for binary relations on 2ℕ which can be defined by a countable set of total continuous functionals on 2ℕ in the same way as the usual resource-bounded reducibilities are defined by an enumeration of appropriate oracle Turing machines. The concept of generalized reducibility comprises a natura resource-bounded reducibilities, but is more general; in particular, it does not involve any kind of specific machine model or even effectivity. The results on generalized reducibilities yield corollaries about specific resource-bounded reducibilities, including several results which have been shown previously in the setting of time or space bounded Turing machine computations. (shrink)