Rare copy number variants have a prominent role in the aetiology of schizophrenia and other neuropsychiatric disorders. Substantial risk for schizophrenia is conferred by large CNVs at several loci, including microdeletions at 1q21.1, 3q29, 15q13.3 and 22q11.2 and microduplication at 16p11.2. However, these CNVs collectively account for a small fraction of cases, and the relevant genes and neurobiological mechanisms are not well understood. Here we performed a large two-stage genome-wide scan of rare CNVs and report the significant association of copy (...) number gains at chromosome 7q36.3 with schizophrenia. Microduplications with variable breakpoints occurred within a 362-kilobase region and were detected in 29 of 8,290 patients versus 2 of 7,431 controls in the combined sample. All duplications overlapped or were located within 89 kilobases upstream of the vasoactive intestinal peptide receptor gene VIPR2. VIPR2 transcription and cyclic-AMP signalling were significantly increased in cultured lymphocytes from patients with microduplications of 7q36.3. These findings implicate altered vasoactive intestinal peptide signalling in the pathogenesis of schizophrenia and indicate the VPAC2 receptor as a potential target for the development of new antipsychotic drugs. © 2011 Macmillan Publishers Limited. All rights reserved. (shrink)

In recent years, organizations worldwide have widely applied the project approach in business and value delivery. Negotiation is essential to the success of a project; however, it has not been explored systematically in the project context. A gap remains between knowledge and practical behavior during negotiation settlements throughout projects. Many project procurement negotiations do not work as expected. This study develops a practical framework using the scientific method to help close the gap and improve PP negotiations. The proposed framework uses (...) the fuzzy TOPSIS method to integrate the PP management process and the three-phase negotiating model. Through this approach, notable variables and potential solutions under uncertain negotiation situations are quantitatively examined in the early stage and managed until the completion of PP. Thus, expected agreements can be obtained in a timely and efficient manner, with negotiating parties committing to implementing what has been agreed on. Such a commitment facilitates win-win outcomes. An example is presented to demonstrate how the proposed framework operates, and practical implications for managers of project-based organizations are offered. This study provides researchers and practitioners with a foundation to study refined models to enhance project negotiations with interdisciplinary integration. (shrink)

BackgroundThe therapeutic effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD) is related to the modulation of pathological neural activities, particularly the synchronization in the β band (13–35 Hz). However, whether the local β activity in the STN region can directly predict the stimulation outcome remains unclear.ObjectiveWe tested the hypothesis that low-β (13–20 Hz) and/or high-β (20–35 Hz) band activities recorded from the STN region can predict DBS efficacy.MethodsLocal field potentials (LFPs) were recorded in (...) 26 patients undergoing deep brain stimulation surgery in the subthalamic nucleus area. Recordings were made after the implantation of the DBS electrode prior to its connection to a stimulator. The maximum normalized powers in the theta (4–7 Hz), alpha (7–13 Hz), low-β (13–20 Hz), high-β (20–35 Hz), and low-γ (40–55 Hz) subbands in the postoperatively recorded LFP were correlated with the stimulation-induced improvement in contralateral tremor or bradykinesia–rigidity. The distance between the contact selected for stimulation and the contact with the maximum subband power was correlated with the stimulation efficacy. Following the identification of the potential predictors by the significant correlations, a multiple regression analysis was performed to evaluate their effect on the outcome.ResultsThe maximum high-β power was positively correlated with bradykinesia–rigidity improvement (rs = 0.549, p < 0.0001). The distance to the contact with maximum high-β power was negatively correlated with bradykinesia–rigidity improvement (rs = −0.452, p < 0.001). No significant correlation was observed with low-β power. The maximum high-β power and the distance to the contact with maximum high-β power were both significant predictors for bradykinesia–rigidity improvement in the multiple regression analysis, explaining 37.4% of the variance altogether. Tremor improvement was not significantly correlated with any frequency.ConclusionHigh-β oscillations, but not low-β oscillations, recorded from the STN region with the DBS lead can inform stimulation-induced improvement in contralateral bradykinesia–rigidity in patients with PD. High-β oscillations can help refine electrode targeting and inform contact selection for DBS therapy. (shrink)

Delineation of the subthalamic nuclei on MRI is critical for deep brain stimulation surgery in patients with Parkinson’s disease. We propose this retrospective cohort study for quantitative analysis of MR signal-to-noise ratio, contrast, and signal difference-to-noise ratio of the STN on pre-operative three-dimensional stereotactic MRI in patients with medication-refractory PD. Forty-five consecutive patients with medication-refractory PD who underwent STN-DBS surgery in our hospital from January 2018 to June 2021 were included in this study. All patients had whole-brain 3D MRI, including (...) T2-weighted imaging, T2-weighted fluid-attenuated inversion recovery, and susceptibility-weighted imaging, at 3.0 T scanner for stereotactic navigation. The signal intensities of the STN, corona radiata, and background noise were obtained after placing regions of interest on corresponding structures. Quantitative comparisons of SNR, contrast, and SDNR of the STN between MR pulse sequences, including the T2WI, FLAIR, and SWI. Subgroup analysis regarding patients’ sex, age, and duration of treatment. We used one-way repeated measures analysis of variance for quantitative comparisons of SNR, contrast, and SDNR of the STN between different MR pulse sequences, and we also used the dependent t-test for the post hoc tests. In addition, we used Mann–Whitney U test for subgroup analyses. Both the contrast and SDNR were highest on FLAIR. The SNR was highest on SWI, and both the SNR and SDNR were lowest on T2WI. Subgroup analyses demonstrated significantly lower SDNR on SWI for patients receiving medication treatment for ≥13 years. In conclusion, on 3D stereotactic MRI of medication-refractory PD patients, the contrast and SDNR for the STN are highest on FLAIR, suggesting the optimal delineation of STN on FLAIR. (shrink)

The objective of this study is to investigate the effects of emotional labor on job performance and satisfaction, as well as to examine the mediating effect of sleep problems and the moderating effects of personality traits. A time-lagged study was conducted on 864 health professionals. Scales for emotional labor, sleep, personality traits, and job satisfaction were used and job performance data was obtained from records maintained by human resources. Structural equation modeling was performed to investigate the relations. Sleep problems only (...) partially mediated the relationship between surface acting and job satisfaction but completely mediated the relationship between surface acting and job performance. Several personality traits were shown to moderate the relationship between surface acting and sleep problems. The effects were stronger for people with low agreeableness and high neuroticism. The relationship between high levels of deep acting and low levels of sleep problems was more pronounced in individuals with low extraversion. Supervisors should be conscious of emotional labor in the work context and provide necessary deep acting training to facilitate emotional regulation. (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)

Ben shu yi si xiang jiao liu wei he xin yi ti, Li zu yu dong ya wen hua chuan bo de xue shu fan chou, Tan tao zhu shun shui yu zhong ri wen hua, Si xiang, Zheng zhi, Xue shu deng fang mian suo qi de ying xiang yu zuo yong.

di 1 juan. Shi lun juan -- di 2 juan. Fan chou juan -- di 3 juan. Men lei juan.

Lei, a twenty‐seven‐year‐old Mandarin speaker, visits the United States seeking curative treatments for his acute myeloid leukemia. His mother, Hua, has traveled with him. Neither she nor Lei speak English, and the hospital does not have an onsite professional Mandarin‐speaking interpreter. Using a professional interpreter over the phone, Lei's oncologist, Dr. Branson, attempts to initiate a face‐to‐face goals‐of‐care conversation with Hua as the surrogate decision‐maker. Dr. Branson explains that Lei has “only weeks to months to live” and recommends initiating comfort‐care‐only (...) measures, but Hua says that she wants (and that Lei would want) continued aggressive measures. Hua says that her son might be a candidate for a phase I trial. Eventually, Dr. Branson brings in Dr. Chou, a Mandarin‐speaking resident to provide face‐to‐face interpretation. Hua insists that “there must be more standard therapies available” and says that she will wait until the trial begins. She begins crying, and the meeting disintegrates. Following this, Dr. Branson calls for an ethics consultation for “help in end‐of‐life communicating and reconciling discordance about prognostic information.”How should the ethicist use the institution's interpreter services? (shrink)

Originally a religious term, from the sixth century B.C. on, the word "t'ien," or "heaven," played a significant role in discourse among philosophical schools. The earliest of these was Juism . This study analyzes statements concerning T'ien in three early Juist texts: the Analects, Mencius, and Hsun Tzu. ;Previous analyses of the role of T'ien in Juism have viewed that role in terms of a model of evolving meanings of "t'ien" during the late Chou period, which claims that (...) the term originally denoted an anthropomorphic deity, but increasingly came to denote "Nature." Studies of the role of T'ien in Juist texts have explored whether this model fits those texts. ;This essay holds that to identify characteristically Juist meanings of the term "t'ien," we must do more than identify referential images which may have been associated with its uses in Juist texts. We should, instead, explore the function which uses of the term may have had in relation to the activities and goals of the early Juist school. ;The focus of those activities and goals has traditionally been understood as a political program. This study argues that early Juism was essentially a socially insular cult devoted to mastery of traditional ritual skills; political purism functioned to shelter the cult from political responsibilities and dangers. ;If this is correct, the role of T'ien in early Juist texts should reflect a disjunction between ritual and political spheres. And indeed we find that throughout the three texts analyzed, the term "t'ien" is generally employed to picture a supreme ethical entity--whether a god, Fate, or Nature--as a prescriptive basis for ritual practice in the present, or as a descriptive force ensuring that Juist political efforts will be futile in the present and successful in the future. ;Thus, in early Juist rhetoric, T'ien is used to justify Juism's ritual focus and legitimize its contemporary withdrawal from political activity. This is the characteristic instrumental meaning of the term "t'ien" in early Juist texts, remaining central despite changes in connotative imagery associated with the term in late Chou thought. (shrink)

Zheng zhi zi you shi wei zi you si xiang di yi yi. Ran er, Zhongguo xian dai zheng zhi zi you guan nian shi ru he dan sheng de zhe ge hua ti tai da, wo men guan zhu de shi ta yu xian Qin zhu zi si xiang zhi jian de guan xi he ru. Ben shu yi shi jian, pai bie wei xian suo, yi lun ti, fan chou he nei zai jie gou wei mai luo, (...) jie he Zhongguo xian dai si xiang jia lun ji zheng zhi zi you he xian Qin zhu zi guan xi de ju ti yan lun, lai tao lun Zhongguo xian dai zheng zhi zi you guan ji qi yu xian Qin zhu zi guan xi, miao mo chu duo ceng ci, duo yuan hua de Zhongguo xian dai zheng zhi zi you lun de bo lan zhuang kuo de si xiang hua mian. (shrink)

Some of the authors of the essays on Chinese philosophers prefer the pin yin system of romanization for Chinese names and words, while others prefer the Wade‐Giles system. Given that both systems are in wide use today, important names and words are given in both their pin yin and Wade‐Giles formulations. The author's preference is printed first, followed by the alternative romanization within brackets.

本书简要介绍了从明中叶至辛亥革命这一历史时期中国文化史上的主流思潮。全书按历史顺序分别评介了晚明人文主义思潮、明清之际启蒙主义思潮、嘉道之际实学思潮和19世纪末—20世纪初的新民思潮。.

Background: As moral action could help nurses reduce moral distress, it is necessary to carry out qualitative research to present the experiences in which nurses apply moral action. Aim: To describe and analyze the phronesis applied by nurses in the face of moral distress. Research design: The research participants were invited to participate in in-depth interviews. The research materials were based on the stories described by the research participants and recorded by means of first-person narrative. Narrative analysis was applied to (...) interpret the nurses’ phronesis. Participants: Twenty-seven nurses from Taiwan. Ethical considerations: The Institutional Review Board of the Kaohsiung Medical University Hospital in Taiwan confirmed that this study passed the research ethical review. Findings: According to the narrative analysis results, the phenomenon of moral distress contains difficulty, action, and idea transformation. The difficulty is the source of moral distress, action is the practice of moral courage, and idea transformation is the nurse’s emotional movement. Action and idea transformation are collectively called phronesis in this study. Discussion: Moral distress refers to a state of suffering caused by situations in which nurses cannot carry out their ethical intentions. Phronesis is the process through which nurses take actions and relocate the subjects and is an ethical way to find relief from moral distress. Starting with empathy and respectful attitudes arising from self-reflection, nurses may be helped to get relief from the suffering of moral distress. Conclusion: Phronesis can help nurses positively face the emotional strain of moral distress. This article puts forward a narrative method to complete the four steps of phronesis: write about the care experience, identify the difficulties in the stories, seek the possibility of action, and form a new care attitude, which could help nurses learn to reduce their moral distress. (shrink)

Why do some democracies self-destruct? Using the collapse of democracy in ancient Athens and the Weimar Republic, as well as the uncertain fate of democratic rule in the United States and China today as illustrative examples, Mark Chou examines the conditions and characteristics of democracy that make it prone to self-destruct. In drawing out the political lessons from these past collapses, he explains how a democracy can, simply by being democratic, sow the seeds of its own destruction.

Hua-Ching Ni encourages each person to go beyond religion and theology in order to rediscover his or her own spiritual nature. He provides the tools with which one can unlock the spiritual treasures of the universe, lighting the way to internal and external harmony and fulfilment.

Background: Most previous studies on moral distress focused on the factors that cause moral distress, paying inadequate attention to the moral conflict of nurses’ values, the physician–nurse power hierarchy, and the influence of the culture. Research objective: To analyze the main causes for moral distress with interpretive interactionism. Research design: A qualitative study was adopted. Participants: Through purposeful sampling, 32 nurses from 12 different departments were chosen as the samples. Ethical considerations: Approval from the Institutional Review Board of the Kaohsiung (...) Medical University Hospital. Findings: Moral distress is likely to occur in the following clinical situations: patients have no idea about their diseases; the medical decisions fail to meet the optimum benefit of patients; and patients with terminal cancers are not given a proper death. The reason why nurses become trapped in moral distress is that they fail to achieve moral goodness. Inadequate confidence, the physician–nurse power hierarchy, and the Oriental culture affect nurses’ goodness-based intention for patients, which deteriorates moral distress. Discussion: The main cause for moral distress is the moral goodness of nurses. If nurses’ goodness-based intention for patients is inconsistent with the moral objective of achieving optimum benefit for patients, it leads to moral distress. Culture is an essential background factor of care for patients. In the Oriental culture, family members influence patients’ right to know about their diseases, the choice of treatment, and patients’ autonomy of not receiving cardio-pulmonary resuscitation. This results in moral distress in medical care. Conclusion: The occurrence of moral distress demonstrates that nurses have moral characteristics such as goodness and caring. It is suggested that appropriate educational strategies can be adopted to weaken the power hierarchy between physicians and nurses and enhance nurses’ confidence and cultural sensitivity, so as to reduce the moral distress of nurses. (shrink)

In this paper, finite-time tracking problem of nonholonomic mobile robots for a moving target is considered. First of all, polar coordinates are used to characterize the distance and azimuth between the moving target and the robot. Then, based on the distance and azimuth transported from the sensor installed on the robot, a finite-time tracking control law is designed for the nonholonomic mobile robot by the switching control method. Rigorous proof shows that the tracking error converges to zero in a finite (...) time. Numerical simulation demonstrates the effectiveness of the proposed control method. (shrink)

This paper describes a pilot study of a new model for narrative medicine training, “community-based participatory narrative medicine”, which centers on shared narrative work between healthcare trainees and patients. Nine medical students and eight patients participated in one of two, five-week-long pilot workshop series. A case study of participants’ experiences of the workshop series identified three major themes: the reciprocal and collaborative nature of participants’ relationships; the interplay between self-reflection and receiving feedback from others; and the clinical and pedagogical implications (...) of the CBPNM model. Principles and proposed outcomes of the CBPNM model are presented. (shrink)

In 2018-2019, at the Keck School of Medicine of the University of Southern California, we developed and piloted a narrative-based health systems science intervention for patients living with HIV and medical students in which medical students co-wrote patients’ life narratives for inclusion in the electronic health record. The pilot study aimed to assess the acceptability of the “life narrative protocol” from multiple stakeholder positions and characterize participants’ experiences of the clinical and pedagogical implications of the LNP. Students were recruited from (...) KSOM. Patients and staff were recruited from the Maternal, Child, and Adolescent/Adult Center for Infectious Disease and Virology at Los Angeles County+USC Medical Center. Ten patients, seventeen students, and ten MCA staff participated in the pilot study. Qualitative methods were used to gather data from students’, patients’, and staff’s perspectives. Three themes emerged from the thematic analysis: patients’ life narratives conveyed their unique life experiences and voices; the protocol could result in wide-ranging effects on HIV care; the LNP enabled students to contribute value to patients’ healthcare. Across groups, participants considered the LNP an acceptable intervention. The LNP, its limitations, and implications for HIV care, narrative medicine, and health information technology are presented. (shrink)

Ben shu chan shu de nei rong shi zhi shi zhong ya fang wen hua de shen tou yu jiao liu.

The search for new ideas often frustratingly cycles back to old ones, a phenomenon known as fixation. Recent research has shown ways to kick‐start finding new uses for familiar objects, a prototypical creativity task: wandering in the mind or the world or working on a messy desk. Those techniques seem to succeed by helping break fixation, but do not guide the search for new ideas. The perspective‐taking or human‐centric or empathic mindset championed by many in HCI and in design firms (...) does provide a search strategy. We compared the mind‐wandering mindset to a perspective‐taking mindset, the latter priming thinking of ways that people in different roles (gardener, artist, etc.) might use the objects. In two studies, the Perspective‐Taking mindset yielded more ideas and more original ideas than Mind‐Wandering, which did not differ from a No‐Mindset control. Original ideas came late, rewarding persistence. The perspective‐taking mindset is productive for problem‐solving, forecasting, and social interactions as well as innovation. (shrink)

Due to the crucial role of customers’ brand citizenship behaviors on brand strength, this study explored the relationship between brand uniqueness, brand credibility, brand intimacy, brand love, and brand citizenship behavior in Taiwan’s restaurant context. The participants are the customers of Wang Steak, a famous restaurant chain in Taiwan. A total of 358 valid responses were gathered from a questionnaire survey, with a response rate of 71.6%. We used structural equation modeling to analyze the data. Brand uniqueness, brand credibility, and (...) brand intimacy all have a positive relationship with brand love. Moreover, brand love was positively associated with brand citizenship behavior. The findings provide greater insights into the relationship of perceived brand uniqueness, brand credibility, brand intimacy, and brand love with customers’ brand citizenship behaviors. (shrink)

Background Ethical dilemmas that arise in the clinical setting often require the collaboration of multiple disciplines to be resolved. However, medical and nursing curricula do not prioritize communication among disciplines regarding this issue. A common teaching strategy, problem-based learning, could be used to enhance communication among disciplines. Therefore, a university in southern Taiwan developed an interprofessional ethics education program based on problem-based learning strategies. This study described tutors’ experience teaching in this program. Aim To explore the phenomenon of teaching and (...) learning in interprofessional ethics education for medical and nursing students from the perspectives of tutors. Design Phenomenological qualitative research. Methods Medical and nursing students completed a 6-week interprofessional ethics education program moderated by either physician or nurse tutors. At the conclusion of the ethics education program, all 14 tutors were invited to participate in focus group interviews. Among them, six tutors (three nursing tutors and three physician tutors) participated in additional individual interviews. All of the contents from the focus group interviews and individual interviews were recorded and transcribed. Using the phenomenological approach, the phenomenon of teaching and learning in interprofessional ethics education were generated. Ethical consideration The study was approved by the Institutional Review Board. Findings Three themes emerged from the tutors' teaching perspectives, including the instructor’s motivation to teach, the use of narrative case scenarios, and the emphasis on improving interprofessional ethics communication. Discussion Problem-based learning creates an interprofessional communication platform in interprofessional ethics education. The phenomenon of value convergence between tutors and students, between different students’ professions, and between different students’ professional maturities is observed. Conclusion Problem-based learning is an effective teaching strategy for creating a communication platform for interprofessional ethics education. Ethic curriculum should emphasize motivating instructor, use narrative case scenarios, and focus on interprofessional communication. (shrink)

Man's interpretations of natural phenomena change and develop gradually in accordance with his knowledge of them and the accumulation of scientific data about them. In studying a subject, it is very important to understand the history of the development of the subject and the general state of theoretical thinking on the subject. By so doing, we can embrace the experience and knowledge secured by scholars in the past and broaden our vision in order to avoid tortuous paths. The author of (...) this article will review biological theories and the history of their development as the beginning of our study of the histories of natural science and philosophy. (shrink)

In this paper, the stabilization problem of nonholonomic chained-form systems is addressed with uncertain constants. In this paper, the active disturbance rejection control is designed to solve this problem. The proposed control strategy combines extended state observer and adaptive sliding mode controller. The control of nonholonomic chained-form systems with dynamic nonlinear uncertain terms and uncertain constants is first discussed in this paper. In comparison with existing methods, the proposed method in this paper has better performance. It is proved that, with (...) the application of the proposed control strategy, semiglobal finite-time stabilization of the systems is achieved. An example is given to illustrate the effectiveness of the proposed method. (shrink)

Naïve realism is the view that veridical experiences are fundamentally relations of acquaintance to external objects and their features, and multidisjunctivism is the conjunction of naïve realism and the view that hallucinatory experiences don’t share a common fundamental kind. Multidisjunctivism allegedly removes the screening-off worry over naïve realism, and the relevant literature suggests that multidisjunctivism is one of the naïve realist responses to the worry. The present paper argues that the multidisjunctive solution is implicitly changing the subject, so the impression (...) that the multidisjunctivist is addressing the screening-off problem is illusory. (shrink)

From the popularity of flipped teaching in United States primary and high schools, it is thought that students have more learning control to adjust to the learning progress and are assisted in problem solving and learning guidance during class period. It is believed that flipped teaching could prompt underachieving learners’ active learning and thereby enhance learning effectiveness. A total of 386 high school students in Chungli, Taiwan, were part of an experimental study and the research results are summarized below: Students (...) who participated in the flipped teaching models demonstrated better comprehension levels with the teaching content due to this change in learning style and attitude, which in turn, enhanced learning effectiveness. To eliminate poor language performance of underachieving students, it is necessary to lay solid foundations to gradually enhance language learning effectiveness regarding this particular group of students. Films suitable for students’ individual ability could be combined with new language learned in the unit to genuinely assist underachieving learners’ language learning effectiveness. For students who care about their performance, a “system of play” style grouping should be determined in order to enable the tracking of group performance and term performance. According to the results, further developments regarding active learning ability, boosts in learning interests, enhanced learning effectiveness, and the prompting of creativity resulting in a shift from passive learner to active learner have been proposed. (shrink)