First published in 2000. Routledge is an imprint of Taylor & Francis, an informa company.

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)

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)

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)

Anxiety can impair the central executive functioning in working memory (WM). Further, the adverse effect of anxiety on the central executive would be greater when threat-related distractors are present. This study investigated the effect of task-irrelevant emotional faces on WM updating in social anxiety. Forty-one socially anxious (SA) and thirty-nine non-anxious (NA) participants completed an emotional face interference n-back task coupled with eye movement recording. The results showed that, in the 2-back task, SA participants had longer reaction times in the (...) angry-neutral and neutral-neutral interference conditions than in the no-interference condition, whereas NA participants had longer reaction times in the happy-neutral and neutral-neutral interference conditions than in the no-interference condition. In addition, SA participants initially fixated on angry faces more frequently and spent more time looking at them, whereas NA participants initially fixated on happy faces more frequently and spent more time looking at them. This study suggests that attentional bias towards social threats reduces the efficiency rather than effectiveness of WM updating in social anxiety. Moreover, SA individuals are better at resisting interference from task-irrelevant positive stimuli, while NA individuals are better at resisting interference from task-irrelevant threatening stimuli. (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)

Antibiotic resistance in bacteria has become a great threat to global public health. Tigecycline is a next‐generation tetracycline that is the final line of defense against severe infections by pan‐drug‐resistant bacterial pathogens. Unfortunately, this last‐resort antibiotic has been challenged by the recent emergence of the mobile Tet(X) orthologs that can confer high‐level tigecycline resistance. As it is reviewed here, these novel tetracycline destructases represent a growing threat to the next‐generation tetracyclines, and a basic framework for understanding the molecular epidemiology and (...) resistance mechanisms of them is presented. However, further large‐scale epidemiological and functional studies are urgently needed to better understand the prevalence and dissemination of these newly discovered Tet(X) orthologs among Gram‐negative bacteria in both human and veterinary medicine. (shrink)

The choice of coping style of recruits under psychological stress in the process of military task execution has been an important topic in the promotion of military operations and cohesion of military forces. Taking a positive coping style under psychological stress can help recruits overcome the negative effects of stress and improve military morale and group combat effectiveness. Although soldiers' psychological stress in the process of military mission execution having an impact on coping style has been studied by a large (...) body of literature, very little literature has focused on the mechanism of self-efficacy and social support between recruits' psychological stress and coping style from the person-environment fit perspective. Therefore, this study was conducted to analyze the impact of recruits' psychological stress on coping style through a chain mediation model and to discuss the role of self-efficacy and social support in this relationship. Two waves of survey data were utilized to test the research hypotheses on a sample of 1028 Chinese recruits performing military tasks. The results indicated that recruits' psychological stress negatively impacted positive coping styles and positively correlated with negative ones. In addition, self-efficacy and social support mediated the relationship between psychological stress and positive coping style, and self-efficacy mediated the relationship between psychological stress and negative coping style. More importantly, self-efficacy and social support play the chain mediating effect between psychological stress and positive coping style. (shrink)

BackgroundRapid advances in medical technology, changing healthcare policies, and increasing patient diversity have exacerbated the ethical challenges. As nursing students are an integral part of the future nursing workforce, ethical sensitivity has a critical impact on their future careers.PurposeThis study aims to promote research in related fields by systematically reviewing the origin and development of the concept of ethical sensitivity in nursing students, comparing currently available tools for assessing ethical sensitivity in nursing students, and exploring their applicability and reliability.MethodsA literature (...) review method was used in this study. A literature search was conducted for assessment tools published between 1995 and 2024. A total of six articles focusing on assessment tools they developed to measure ethical or moral sensitivity were included and analyzed.ResultsOur analysis revealed significant variations in the reliability and applicability of these assessment tools, particularly when used in diverse cultural settings. The study also identified a need for localized modifications of these tools to ensure their accuracy and relevance in different regions.ConclusionThe findings provide valuable guidance for nursing educators in selecting appropriate assessment tools and offer a foundation for developing new tools that are more contextually relevant. This study contributes to the advancement of ethical sensitivity education for nursing students worldwide, ultimately enhancing patient care and professional development. (shrink)

The opposition of "person" [jen] to "people" [min] in the Analects [Lun-yü] was a fundamental contradiction of the slave system of the late Spring and Autumn period. The "people not following their rulers" combined with the insur-rections of the "vassals" and "tradespeople" to become a great motive force for the transition to feudalism; in turn, the splits within the slave-owning class, the so-called "violent acts" of the "rebellious ministers and bad sons," made use of the strength of the people for (...) seizures of political power. (shrink)

The purposes of research were to describe the neonatal clinicians' personal views and attitudes on neonatal ethical decision-making, to identify factors that might affect these attitudes and to compare the attitudes between neonatal physicians and neonatal nurses in Taiwan. Research was a cross-sectional design and a questionnaire was used to reach different research purposes. A convenient sample was used to recruit 24 physicians and 80 neonatal nurses from four neonatal intensive care units in Taiwan. Most participants agreed with suggesting a (...) do not resuscitate (DNR) order to parents for dying neonates (86.5%). However, the majority agreed with talking to patients about DNR orders is difficult (76.9%). Most participants agree that review by the clinical ethics committee is needed before the recommendation of ‘DNR’ to parents (94.23%) and nurses were significantly more likely than physicians to agree to this (p=0.043). During the end-of-life care, most clinicians accepted to continue current treatment without adding others (70%) and withholding of emergency treatments (75%); however, active euthanasia, the administration of drug to end-of-life, was not considered acceptable by both physicians and nurses in this research (96%). Based on our research results, providing continuing educational training and a formal consulting service in moral courage for neonatal clinicians are needed. In Taiwan, neonatal physicians and nurses hold similar values and attitudes towards end-of-life decisions for neonates. In order to improve the clinicians' communication skills with parents about DNR options and to change clinicians' attitudes for providing enough pain-relief medicine to dying neonates, providing continuing educational training and a formal consulting service in moral courage are needed. (shrink)

A critical issue in executive control is how the nervous system exerts flexibility to inhibit a prepotent response and adapt to sudden changes in the environment. In this study, force measurement was used to capture “partial” unsuccessful trials that are highly relevant in extending the current understanding of motor inhibition processing. Moreover, a modified version of the stop-signal task was used to control and eliminate potential attentional capture effects from the motor inhibition index. The results illustrate that the non-canceled force (...) and force rate increased as a function of stop-signal delay, offering new objective indices for gauging the dynamic inhibitory process. Motor response was a function of delay in the presentation of novel/infrequent stimuli. A larger lateralized readiness potential amplitude in go and novel stimuli indicated an influence of the novel stimuli on central motor processing. Moreover, an early N1 component reflects an index of motor inhibition in addition to the N2 component reported in previous studies. Source analysis revealed that the activation of N2 originated from inhibitory control associated areas: the right inferior frontal gyrus, pre-motor cortex, and primary motor cortex. Regarding partial responses, LRP and error-related negativity were associated with error correction processes, whereas the N2 component may indicate the functional overlap between inhibition and error correction. In sum, the present study has developed reliable and objective indices of motor inhibition by introducing force, force-rate and electrophysiological measures, further elucidating our understandings of dynamic motor inhibition and error correction. (shrink)

This study aimed to test the association between personality traits and affect among boxers and to figure out whether loneliness mediated this relationship. This study used The Big Five Personality Traits Scale, The UCLA Loneliness Scale, and The Positive and Negative Affect Scale which were administered to N = 231 boxers, of which 62% were male and 38% were female. The results showed that conscientiousness, extraversion, and agreeableness were negatively related with negative affect, neuroticism was positively associated with negative affect, (...) and openness showed no relationship with negative affect; conscientiousness, extraversion, and agreeableness were all positively correlated with positive affect, neuroticism was negatively associated with positive affect, and openness showed no relationship with positive affect; conscientiousness, extraversion, openness, and agreeableness were negatively related with loneliness and neuroticism was positively associated with loneliness; and loneliness was positively associated with negative affect; loneliness was negatively associated with positive affect; and loneliness had mediating effect on the relationship between the personality traits and affect. Furthermore, these findings suggest that loneliness might be one mechanism explaining how boxer’s personality traits influence their athletic performance. Therefore, in the future, we should start by helping them reduce their loneliness to reduce their negative affect and improve their positive affect and also, in some degree, to enhance boxers’ athletic ability and mental quality health. (shrink)

The whale optimization algorithm is a powerful swarm intelligence method which has been widely used in various fields such as parameter identification of solar cells and PV modules. In order to better balance the exploration and exploitation of WOA, we propose a novel modified WOA in which both the mutation strategy based on Levy flight and a local search mechanism of pattern search are introduced. On the one hand, Levy flight can make the algorithm get rid of the local optimum (...) and avoid stagnation; thus, it is able to prevent the algorithm from losing diversity and to increase the global search capability. On the other hand, pattern search, a direct search method, has not only high convergence rate but also good stability, which can boost the local optimization ability of the WOA. Therefore, the combination of these two mechanisms can greatly improve the capability of WOA to obtain the best solution. In addition, MWOA may be employed to estimate parameters in single diode model, double diode model, and PV modules and to identify unknown parameters of two different types of PV modules under diverse light irradiance and temperature conditions. The analytical results demonstrate the validity and the practicality of MWOA for estimating parameters of solar cells and PV modules. (shrink)

Fraud can cause severe financial losses and affect the physical and mental health of victims. This study aimed to explore the manipulative characteristics of fraudsters and their relationship with other psychological variables. Thirty-four fraudsters were selected from a medium-security prison in China, and thirty-one healthy participants were recruited online. Both groups completed an emotional face-recognition task and self-report measures assaying emotional manipulation, psychopathy, emotion recognition, and empathy. Results showed that imprisoned fraudsters had higher accuracy in identifying fear and surprise faces (...) but lower accuracy in identifying happiness than controls. Significantly lower scores on non-prosocial factors on the Managing the Emotions of Others scale were found for imprisoned fraudsters, relative to controls. Imprisoned fraudsters had low scores in the assessment of psychopathy than the control group, especially Factor 1. For empathy, imprisoned fraudsters had significantly higher scores in perspective-taking than controls. Correlation analyses revealed that psychopathic traits were positively correlated with non-prosocial factors in both groups. However, the relationships between emotional manipulation and emotional recognition and empathy were not consistent across the groups. The results suggest that fraudsters may pretend to be as prosocial as healthy controls, who had lower antisocial tendencies, normal empathy ability, and would like to manipulate others’ emotions positively during social interaction. (shrink)

Based on attribution theory, this research defines pseudo-transformational leadership to be driven by the interaction between transformational leadership and the subordinates’ perception of their supervisor’s manipulative intention. We investigate the effects of pseudo-transformational leadership on contextual performance through organizational identification. The results of hierarchical linear modeling using a sample of 214 subordinates reporting to 66 supervisors show that when subordinates perceive that their supervisor has a high level of manipulative intention, the impact of group-level transformational leadership on the subordinates will (...) be reduced. More specifically, when subordinates perceive the manipulative intention of transformational leadership, they are less likely to identify with the organization, which ultimately limits their willingness to demonstrate contextual performance activities. The implications of these findings for theory as well as managerial practice are discussed. (shrink)

Life education, also known as life and death education, is an important subject in Taiwan with institutions offering degree programs and courses that focus on quality learning and implementation of life education. What is interesting from the perspective of Taiwanese Education is that the teaching of life education also incorporates a number of Eastern-derived and conceptualized tenets, for example, Buddhist teaching and the importance of spiritual wisdom. This premise contends then that life education in Taiwan, in general, is concerned with (...) the promotion, fulfillment, and cherishing of quality life experiences (e.g., personal contentment, happiness). One example of life education, which resonates with other spiritual beliefs and religious faiths (e.g., Hinduism), is related to spiritual cultivation and the enlightenment of life wisdom. Our own teaching of the subject, likewise, places emphasis on the goal of teaching students to seek meaningful understanding of and appreciation for three major, interrelated components of life education: life wisdom, life practice, and life care. Life education is a beneficial subject as its theoretical understanding may help individuals cope with pathologies and negative life experiences. One negative life experience, in this case, is the ultimate fate of humankind: death. Approaching death and/or the onset of grief is something that we all have to experience. How does one approach death? It is not easy feat and, of course, grief for a loved one is personal and some of us struggle with this. We contend that spiritual cultivation and enlightenment, arising from life education, may assist us with the coping of death (e.g., the possibility of transcendence beyond the realm of life). Forming the premise of the present article, we propose that a person’s ‘spiritual and enlightened self’, reflecting the convergence of three major aspects of life education (i.e., Philosophical reflection, Enrichment of personal well-being, and Spiritual cultivation), would result in the initiation and creation of a number of virtues and positive characteristics – for example: having a positive outlook in life, showing compassion, forgiveness, etc. These virtues and quality characteristics, from our philosophical reasoning, are equivalent to those qualities that positive psychology advocates for. (shrink)

Attending cram school has long been a trend in ethnic Chinese culture areas, including Taiwan. Despite the fact that school reform policies have been implemented in Taiwan, cram schools have continued to prosper. Therefore, in this educational culture, how to achieve a good educational effect is also a topic worthy of discussion. However, whether students really engage in those tutoring programs provided by cram schools has seldom been studied. To address this gap, this study explored how parents’ hovering attitude toward (...) life and coursework influences their children’s engagement in cram schools. This study targeted those students who attend English cram schools to test the correlates between two types of helicopter parenting, tutoring engagement and continued attendance at cram schools. A total of 320 questionnaires were sent out, and 300 were returned, giving an overall response rate of 93.75%. Excluding seven incomplete or invalid questionnaires, 293 valid questionnaires were received. The results of this study show that hovering behavior awareness is negatively related to cram school engagement, whereas cram school engagement is positively related to the intention to continue attending cram school. Moreover, the results imply that parents should alleviate their helicoptering behavior to enhance their children’s engagement in cram school tutoring programs. (shrink)