BackgroundAlthough the Life-Sustaining Treatment (LST) Decision Act was enforced in 2018 in Korea, data on whether it is well established in actual clinical settings are limited. Hospital-acquired pneumonia (HAP) is a common nosocomial infection with high mortality. However, there are limited data on the end-of-life (EOL) decision of patients with HAP. Therefore, we aimed to examine clinical characteristics and outcomes according to the EOL decision for patients with HAP.MethodsThis multicenter study enrolled patients with HAP at 16 referral hospitals retrospectively from (...) January to December 2019. EOL decisions included do-not-resuscitate (DNR), withholding of LST, and withdrawal of LST. Descriptive and Kaplan–Meier curve analyses for survival were performed.ResultsOf 1,131 patients with HAP, 283 deceased patients with EOL decisions (105 cases of DNR, 108 cases of withholding of LST, and 70 cases of withdrawal of LST) were analyzed. The median age was 74 (IQR 63–81) years. The prevalence of solid malignant tumors was high (32.4% vs. 46.3% vs. 54.3%, P = 0.011), and the ICU admission rate was lower (42.9% vs. 35.2% vs. 24.3%, P = 0.042) in the withdrawal group. The prevalence of multidrug-resistant pathogens, impaired consciousness, and cough was significantly lower in the withdrawal group. Kaplan–Meier curve analysis revealed that 30-day and 60-day survival rates were higher in the withdrawal group than in the DNR and withholding groups (log-rank P = 0.021 and 0.018). The survival of the withdrawal group was markedly decreased after 40 days; thus, the withdrawal decision was made around this time. Among patients aged below 80 years, the rates of EOL decisions were not different (P = 0.430); however, mong patients aged over 80 years, the rate of withdrawal was significantly lower than that of DNR and withholding (P = 0.001).ConclusionsAfter the LST Decision Act was enforced in Korea, a DNR order was still common in EOL decisions. Baseline characteristics and outcomes were similar between the DNR and withholding groups; however, differences were observed in the withdrawal group. Withdrawal decisions seemed to be made at the late stage of dying. Therefore, advance care planning for patients with HAP is needed. (shrink)

While social interaction and play in a VR environment are becoming ever more popular, little is known about how social VR games affect users. The purpose of this study was to elucidate the role of several contingent factors in social VR games by modeling the relationships between involvement, well-being, depression, self-esteem, and social connectedness. A conditional process-moderated mediation model of the measured variables was analyzed with 220 pieces of collected data. The result showed that: the direct effect of involvement on (...) well-being was significant, and the index of moderated mediation involving depression, self-esteem, and social connectedness was significant. We conclude that high levels of involvement in social VR games by socially isolated users with low self-esteem can negatively affect their well-being. The findings of this study contribute in several ways to our understanding of the effect of social VR games upon users and provide important practical implications. (shrink)

Virtual reality is a rapidly developing technology that simulates the real world. However, for some cybersickness-susceptible people, VR still has an unanswered problem—cybersickness—which becomes the main obstacle for users and content makers. Sensory conflict theory is a widely accepted theory for cybersickness. It proposes that conflict between afferent signals and internal models can cause cybersickness. This study analyzes the brain states that determine cybersickness occurrence and related uncomfortable feelings. Furthermore, we use the electroencephalogram microstates and functional connectivity approach based on (...) the sensory conflict theory. The microstate approach is a time–space analysis method that allows signals to be divided into several temporarily stable states, simultaneously allowing for the exploration of short- and long-range signals. These temporal dynamics can show the disturbances in mental processes associated with neurological and psychiatric conditions of cybersickness. Furthermore, the functional connectivity approach gives us in-depth insight and relationships between the sources related to cybersickness. We recruited 40 males, and they watched a VR video on a curved computer monitor for 10 min to experience cybersickness. We recorded the 5-min resting state EEG and 10-min EEG while watching the VR video. Then, we performed a microstate analysis, focusing on two temporal parameters: mean duration and global explained variance. Finally, we obtained the functional connectivity data using eLoreta and lagged phase synchronization. We discovered five sets of microstates, including four widely reported canonical microstates, during baseline and task conditions. The average duration increased in microstates A and B, which is related to the visual and auditory networks. The GEV and duration decreased in microstate C, whereas those in microstate D increased. Microstate C is related to the default mode network and D to the attention network. The temporal dynamics of the microstate parameters are from cybersickness disturbing the sensory, DMN, and attention networks. In the functional connectivity part, the LPS between the left and right parietal operculum significantly decreased compared with the baseline condition. Furthermore, the connectivity between the right OP and V5 significantly decreased. These results also support the disturbance of the sensory network because a conflict between the visual and vestibular system causes cybersickness. Changes in the microstates and functional connectivity support the sensory conflict theory. These results may provide additional information in understanding brain dynamics during cybersickness. (shrink)

The purpose of this study was to investigate the relationship between organizational ethical context and the individual ethical decision-making process. In addition, a new statistical approach combining cluster and discriminant analyses was developed to overcome violations of regression assumptions, which are commonly not identified and/or ignored in behavioral and psychological research. Using regressions and this new alternative method, the findings indicated that ethical context does indeed influence the various components of ethical reasoning. However, social desirability was the strongest predictor of (...) ethical decision making, which raises new concerns about how this bias can confound business ethics research. Finally, the findings showed that the alternative method provided more useful and interpretive results, indicating that it has the capacity to influence future empirical work in the field of business ethics, particularly when dealing with data that do not satisfy regression assumptions. The implications and limitations of the study are discussed, and several noteworthy suggestions for future research are provided. (shrink)

Background Nurses providing care to patients with end-of-life or terminal illnesses often encounter ethically challenging situations leading to moral distress. However, existing quantitative studies have examined moral distress using instruments that address general clinical situations rather than those specific to end-of-life care. Furthermore, qualitative studies have often been limited to participants from a single unit or those experiencing moral distress-induced circumstances. A comprehensive and integrated understanding of the overarching process of moral distress is vital to discern the unique circumstances surrounding (...) end-of-life care and its consequential impacts. Research objectives To explore the moral distress experiences of nurses who are frequently involved in caring for patients with end-of-life or terminal illnesses and apply it to two existing theories: the model of moral distress and the ecological model. Research design A qualitative descriptive approach was employed. Participants and research context Seven focus group interviews involving 30 nurses were performed. The subsequent transcriptions underwent rigorous content analysis. Ethical considerations We obtained Institutional Review Board approval from a university. Focus group interviews were conducted with nurses who agreed to participate and signed the consent form. Findings The moral distress-inducing factors and nurses’ perceived impact of moral distress were identified and categorized based on moral distress theories and ecological models. A total of 15 categories and 30 subcategories across the following 4 domains were derived: (1) intrapersonal, (2) interpersonal, (3) organizational, and (4) structural factors. Conclusions End-of-life-specific circumstances induced moral distress among nurses, with both negative and positive impacts identified. Effective organizational and policy support is essential to manage conflicts, form a healthy organizational culture, provide training, and prevent unnecessary expenses due to the negative consequences of moral distress. (shrink)

Smartphone app-use patterns will predict professional golfers’ athletic performance, and the use time of serious apps would be associated with improved performance. This longitudinal 4-week observation of 79 professional golfers assessed golf handicaps and smartphone app-use patterns at the start of the Korean professional golf season and 2 and 4 weeks later. We classified use as social networking, entertainment, serious apps, and others. Use time of entertainment apps increased for non-improved golfers but did not change for improved golfers. Use time (...) of serious apps increased for improved golfers and decreased for non-improved ones. Changes in golf handicaps were positively correlated with changes in entertainment app use time and negatively correlated with changes in serious app use time. Professional golfers’ sports performance was not associated with smartphone use time but was with the smartphone app type. The management of smartphone app-use patterns is important for professional golfers’ performance. (shrink)

BackgroundExperience with open disclosure and its study are restricted to certain western countries. In addition, there are concerns that open disclosure may be less suitable in non-western countries. The present study explored and compared the in-depth perceptions of the general public and physicians regarding open disclosure in Korea.MethodsWe applied the COREQ checklist to this qualitative study. We conducted 20 in-depth interviews and four focus group discussions with 16 physicians and 18 members of the general public. In-depth interviews and focus group (...) discussions were performed according to semi-structured guidelines developed according to a systematic review of open disclosure. We conducted a directed content analysis by analyzing the verbatim transcripts and field notes in accordance with the predetermined guidelines.ResultsOpen disclosure perceptions were summarized in terms of the “five Ws and one H”. All physician and general public participants acknowledged the normative justifiability of open disclosure. The participants mostly agreed on the known effects of open disclosure, but the physicians had negative opinions on its expected effects, such as decreased intention of the general public to file lawsuits and increased credibility of medical professionals. Generally, the participants thought that open disclosure is required for medical errors causing major harm. However, the physicians and general public had conflicting opinions on the need for open disclosure of near misses. Most physicians did not know how to conduct open disclosure and some physicians had bad experiences due to inappropriate or incomplete open disclosure.ConclusionPhysicians and the general public in Korea acknowledge the need for open disclosure. Guidelines according to the type of patient safety incident are required to encourage physicians to more readily conduct open disclosure. Furthermore, hospitals need to consider organizing a dedicated team and hiring experts for open disclosure. (shrink)

How can corporate social responsibility initiatives influence brand love? Based on the theory of social identity complexity, we examined whether greater complexity of a sport fan’s multiple identifications with sport leagues led to higher multicultural tolerance and more positive perceptions of leagues’ corporate social responsibility activities. Further, brand authenticity was tested as a variable intervening between perceived corporate social responsibility and brand love. We analyzed this serial mediation effect impacting sport fans’ brand love for their multiple, favored and less favored, (...) sport leagues. Participants answered the scale item questionnaire for model assessment. The hypothesized model was supported as the indirect effect through all mediators was significant. Our results suggest that when sport fans acknowledge a high overlap among league fan groups, their tolerance is more likely to be higher than those who have a low overlap. Such high levels of tolerance influence how fans perceive corporate social responsibility initiatives, and these effects build up for fans to perceive the brand to be more authentic. These antecedents affected brand love through a serial mediation. Sport league managers should consider the diverse aspects across leagues for harmonious coexistence with other leagues and maintain brand authenticity for their social initiatives to result in a greater brand love in the consumer’s mind. (shrink)

How can sport community involvement influence life satisfaction during a pandemic? Self-expansion theory posits that individuals seek to gain resources such as positive interpersonal relationships for growth and achievement. By considering psychological capital as a dispositional resource intervening between sport community involvement and life satisfaction, we examined an empirical model to test the chain of effects. Based on the stress process model, distress and generational group were tested as moderators. Participants responded to the scale item questionnaire for model assessment. Supporting (...) the hypothesized relationships, the model was supported with a significant moderated-moderated mediation. The mediation effect of PsyCap was stronger when distress level was lower and such interaction effect was amplified for Generation Z. Whereas the global sport communities and Gen Z were found to be more particularly vulnerable to COVID-19, our findings suggest that there are psychological pathways for fans to maintain their resilience. It is foremost imperative to lower the stress level of sport fans for their community involvement to positively affect life satisfaction. Gen Z were more stressed during the pandemic but individuals who managed to cope with stress were able to leverage community involvement to boost positive psychological resources. Acknowledgment of these effects brings implications for better management strategies and provides avenues for new research. (shrink)

The result of 2007’s presidential election in South Korea symbolizes the decline of the Left and the growth of the new Right. They say it goes with the global retrogression of democracy, or the consolidation of the hegemony of the rightist versions of democracy. According to Choi Jang-jip, the general public in Korea has thought that the Roh Moo-hyun’s administration had betrayed them, handing power over to the market, and seeking to form a coalition government with theconservatives. Similarly, Professor (...) Jang Ha-jun asserts that the democratic governments of Kim Dae-jung and Roh Moo-hyun have mistaken economic democratization for neo-liberalistic structural adjustment. (shrink)

본 연구의 목적은 고현향약에 대한 선행연구의 오류를 바로잡고, 선행연구에서 온전하 게 살펴보지 못했던 고현향약의 전기 규약에 대해 살펴보는 것이다. 고현향약은 현존하는 대한민국의 가장 오래된 향약 가운데 하나로 조선시대 지역자치조직 및 그 규약의 모습을 규명하는데 매우 중요한 자료이다. 조선이 건국된 지 100년도 되기 전부터 실시되어 시대 적 부침 속에서 존속하며 현재까지 지속되고 있는 고현향약을 정밀하게 분석할 수 있다면 우리는 전통 지역자치조직의 모습을 좀 정확하게 규명할 수 있을 것이다. 그리고 이와 같 은 연구를 통해 우리 사회의 바람직한 지역자치조직의 모델도 제시할 수 있을 (...) 것이다. 그런데 문제는 현재 고현향약과 관련된 규약의 전모가 제대로 규명되지 않고 있다는 것 이다. 고현향약 관련 선행 연구가 몇 건 있긴 하지만 이들 연구에 오류가 있기 때문이다. 이러한 이유로 현존하는 고현향약의 최고(最古) 규약이 무엇인지, 그러한 규약이 언제, 어 떤 배경과 목적에 의해 몇 차례 수정을 거쳤는지 등에 대한 연구가 명확히 이루어지지 않 고 있다. 토대 자료에 대한 연구가 미비하거나 그것에 오류가 있다고 한다면 더 이상의 연 구를 진행하기 어렵다. 이러한 문제를 해결하기 위해 본 논문에서는 먼저, 선행연구의 오 류를 바로잡아 11차례에 걸쳐 개정된 고현향약의 규약을 시대순으로 분류하였다. 다음으 로 선행연구에서 다루었던 규약 가운데 특히 오류가 많았던 초기 규약에 대한 전문을 소개 하고, 그것에 대해 간략히 분석하였다. (shrink)

I. Singminji sigi p'yŏn -- II. Chŏnhwan'gi ŭi iron oe.

Exegetical works on Buddhist doctrines and philosophies according to the interpretation of Sa-skya-pa sect.

Predominantly on Tibetan Buddhist doctrines and philosophy.

This Correspondence argues in response to Coolsaet et al. (2024) that there is an important role to play for stance-independent justice discussions that are not tied to specific social, political or critical perspectives. These can be valuable for climate research audiences, but also as a basis upon which to critically debate and research injustices.

Luke Elson defends carbon offsetting on the basis that it is not morally objectionable to shift harms or risks around. As long as emitting and offsetting does not increase the overall harms or risks—and merely shifts them—compared to refraining from emitting, he suggests there is no injustice involved. I respond in several ways, suggesting that the time delay involved in offsetting can increase these risks but, regardless, there is a defensible default which could justify refraining from emitting, even when planning (...) to offset. [Open access]. (shrink)

: Many adolescent patients with chronic medical conditions do not manage their illnesses very closely and often put themselves at risk for serious health complications. Setting aside cases of nonadherence that are due to practical difficulties involving the implementation of a management plan, a deeply problematic question remains. How should health care providers respond to adolescent patients who express a conscious and value-driven decision to pursue other goals and interests that are incompatible with their doctors' recommended directives? Using two guiding (...) ethical principles, the "relevant difference principle" and the "principle of noninterference," as well as available empirical data on adolescent decision making and risk perception, the paper concludes that most adolescents ages 14 and older should be allowed to make self-determining decisions regarding the management of their chronic medical conditions. (shrink)

This article delves into the examination of the similarities and disparities between education and enhancement, with a particular focus on enhancement within the realm of NBIC (Nano-Bio-Information Technology, Cognitive Science). After scrutinizing how proponents of enhancement have delineated the concept of education, our investigation unfolds along two primary dimensions: the anthropological underpinnings of education and enhancement discourse and their respective objectives. Through this analysis, we assert that education and enhancement exhibit distinct characteristics and objectives, defying easy comparison for determining which (...) approach is more conducive to human improvement, notwithstanding their superficially analogous theoretical frameworks and objectives. Furthermore, we aim to highlight the perceptual illusions that blur the demarcation lines between education and enhancement, in order to establish a clear and distinctive role for education amid the plethora of enhancement discourses. (shrink)

Nishida in his writings pursued two main lines of thought, which are almost equally pervasive and persistent. These are the philosophy of self-consciousness, which is mainly religious and soteriological, and the philosophy of history-politics, which is fundamentally historical and political. Both philosophies are essentially ontologies, by virtue of the application of ontological operators. These operators function in almost every phase of Nishida's philosophy, with the notable exception of his discussion of the sciences, and in the main include activity, self-determination, actuality, (...) one-qua-many logic, and immanent-qua-transcendent logic. Once they are at work, whatever entity they apply to will have full reality in Nishida's texts. In general, the operators are applied in turn to pure experience, an artistic creation, an act of self-consciousness, a historical epoch, the state, and the Emperor, in their chronological order in Nishida's texts. The extension of his ontological operators from acts of self-consciousness to a historical epoch is what I call the turn in Nishida's philosophy. This occurred about 1931 and is the most decisive shift in Nishida's philosophy, because it paved the way for Nishida's return to the world which he had once rejected and called transitory. This turn signifies that the applications of these ontological operators are turned from conscious phenomena to non-conscious phenomena, and also reflects Nishida's own critical stance toward his earlier religious-soteriological philosophy. ;Nishida's extension of ontological operators to his historical-political thinking, or his assertion of a direct union of self-consciousness and the historical world, is seen as fundamentally inappropriate. It fails to appreciate the incompleteness of a historical epoch and the culpability of the state. I call this union a category mistake, since acts of self-consciousness and a historical epoch are not similar enough to be treated by similar ontological operators. Nishida's later philosophy may be seen as his effort to overcome his earlier sharp distinction between homo interior and homo exterior by giving fuller reality to the latter. But the manner in which Nishida overcomes his internalism remains fundamentally internal, since the ontological operators themselves, which he uses to overcome that internalism, are originated from his discussion of aesthetic creativity and creative acts of self-consciousness. (shrink)

One branch of the responsible innovation literature involves the direction of innovation: if the public or decision-makers can or should direct innovation, how should innovation be directed? This paper explicates a case study where directionality – the plurality of plausible values for innovation – is directly implicated. In this case, a key technology may require a strategy for innovation, but there are contrasting normative reasons to drive that innovation in different ways, reflecting two distinct moral values, ‘effectiveness’ and responsiveness to (...) ‘need’. In this case, carbon dioxide removal, these values may well conflict. Strategically deploying carbon dioxide removal in a cost-effective manner would tend to support siting it in regions where there are significant oil and gas operations. In contrast, strategically deploying carbon dioxide removal in response to need would tend to support siting it in regions where expected demand for the technology is required for development. [Open access]. (shrink)

This study examines the challenges of humanism and education in the 21st century as addressed by the German philosopher Peter Sloterdijk in his Elmau Speech (1999). In this lecture, titled _Rules for the Human Zoo_, Sloterdijk argues that the traditional notion of humanism, specifically “humanism as a literary society,” has reached its conclusion, necessitating the development of a new humanism appropriate for the contemporary era. However, the new concept of humanism emerging from what Sloterdijk terms the “anthropotechnic turn” appears to (...) align with the discourses surrounding human enhancement that have emerged in the 21st century, thereby influencing the realm of education. The first half of this article reports on the significant concerns and criticisms expressed by the media at that time regarding this new humanism, which seems to be associated with eugenicist ideas. Taking a step further, this study critically examines the nature of the challenges around education implied by Sloterdijk, specifically the conflict between “friend of humans and friend of Übermensch”, and explores the potential roles and responsibilities of education in the latter part of the paper. (shrink)

The body of this essay is free of philosophical jargons. Since however some readers are accustomed to thinking about the free-will problem in terms of the compatibilism/incompatibilism divide, I wish to briefly comment on why this emphasis is not very helpful. If by “freedom” one means that a person’s will is the ultimate choicemaker free from prior causes, then the position of this essay is that “freedom is incompatible with determinism”; but if by “freedom” one means that there is harmony (...) between the intended consequences of a choice and the nature of the choice-maker, the position of this essay is that “freedom is compatible with determinism.” This illustrates that unless there is first an agreement on what is meant by “freedom,” it is premature to put the focus on whether freedom is compatible with determinism. (shrink)

Substituted judgement is often used in the absence of advanced directives to guide decision-making when patients lack decisional capacity. We present a remarkable case of family members exercising substituted misjudgement for a 42-year-old man hospitalized with multiorgan failure on life support. Feeling that their loved one would rather die than face severe disability, they elected to withdraw life support. Although this was done, the patient remained alive and recovered enough to clearly indicate his preference for life, even with severe disability. (...) This case suggests that in instances of unusual quality-of-life judgements where the patient's wishes cannot be known with reasonable certainty, families and physicians should be very wary using substituted judgement to refuse life support. Unless there are strong considerations based on the patient's prior statements, actions and values to decline life support, it would seem ethically appropriate to continue treatment, even with substantial disability the likely outcome. (shrink)