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)

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)

Judging similarities among objects, events, and experiences is one of the most basic cognitive abilities, allowing us to make predictions and generalizations. The main assumption in similarity judgment is that people selectively attend to salient features of stimuli and judge their similarities on the basis of the common and distinct features of the stimuli. However, it is unclear how people select features from stimuli and how they weigh features. Here, we present a computational method that helps address these questions. Our (...) procedure combines image-processing techniques with a machine-learning algorithm and assesses feature weights that can account for both similarity and categorization judgment data. Our analysis suggests that a small number of local features are particularly important to explain our behavioral data. (shrink)

The distinction between the first-person perspective (1PP) and the third-person perspective (3PP) has been widely regarded as fundamental and rigid, and many researchers hold that genuine bodily illusions can only be experienced from the 1PP. We applied VR technology to investigate whether this mainstream view is correct. In our experiments, the participants were immersed in a VR environment in which they saw a life-sized virtual body either from the 1PP or from the 3PP. They either passively received tactile stimulations and/or (...) actively interacted with a virtual soccer ball. Our VR system created novel visuo-motor-tactile correlations between the real and the virtual world: when the participant interacted with a real plastic soccer ball, he/she would feel corresponding tactile sensations and see the avatar performing the exact same movements. We found that a clear sense of ownership over the avatar was induced not only in the 1PP condition but also in the Passive-3PP and the Active-3PP conditions. We also observed evidence suggesting that it is possible to experience one’s body-location, 1PP-location, as well as self-location, both from the 1PP and from the 3PP. Together, we demonstrate that there is in fact no fundamental gap between embodied 1PP and embodied 3PP in the virtual world. (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)

Physicians play a substantial role in facilitating communication regarding life-supporting treatment decision-making including do-not-resuscitate in the intensive care units. Physician-related fact...

Obtaining adequate informed consent from trauma patients is challenging and time-consuming. Healthcare providers must communicate complicated medical information to enable patients to make informed decisions. This study aimed to explore the challenges of obtaining valid consent and methods of improving the quality of the informed consent process for surgical procedures in trauma patients. We conducted a systematic review of relevant English-language full-text original articles retrieved from PubMed that had experimental or observational study design and involved adult trauma patients. Studies involving (...) informed consent in clinical or research trials were excluded. Titles and abstracts of searched articles were reviewed and relevant data were extracted with a structured form. Results were synthesized with a narrative approach. A total of 2044 articles were identified in the initial search. Only eight studies were included in the review for narrative synthesis. Six studies involved orthopedic surgeries, one involved nasal bone surgeries, and one involved trauma-related limb debridement. Only one study was conducted in an emergency department. Information recall was poor for trauma patients. Risk recall and comprehension were greater when written or video information was provided than when information was provided only verbally. Patient satisfaction was also greater when both written and verbal information were provided than when verbal information alone was provided; patients who received video information were more satisfied than patients who received written or verbal information. Many articles have been published on the subject of informed consent, but very few of these have focused on trauma patients. More empirical evidence is needed to support the success of informed consent for trauma patients in the emergency department, especially within the necessarily very limited time frame. To improve the informed consent process for trauma patients, developing a structured and standardized informed consent process may be necessary and achievable; its effectiveness would require evaluation. Adequately educating and training healthcare providers to deliver structured, comprehensive information to trauma patients is crucial. Institutions should give top priority to ensuring patient-centered health care and improved quality of care for trauma patients. (shrink)

Background Individual physicians and physician-associated factors may influence patients’/surrogates’ autonomous decision-making, thus influencing the practice of do-not-resuscitate orders. The objective of this study was to examine the influence of individual attending physicians on signing a DNR order. Methods This study was conducted in closed model, surgical intensive care units in a university-affiliated teaching hospital located in Northern Taiwan. The medical records of patients, admitted to the surgical intensive care units for the first time between June 1, 2011 and December 31, (...) 2013 were reviewed and data collected. We used Kaplan–Meier survival curves with log-rank test and multivariate Cox proportional hazards models to compare the time from surgical intensive care unit admission to do-not-resuscitate orders written for patients for each individual physician. The outcome variable was the time from surgical ICU admission to signing a DNR order. Results We found that each individual attending physician’s likelihood of signing do-not-resuscitate orders for their patients was significantly different from each other. Some attending physicians were more likely to write do-not-resuscitate orders for their patients, and other attending physicians were less likely to do so. Conclusion Our study reported that individual attending physicians had influence on patients’/surrogates’ do-not-resuscitate decision-making. Future studies may be focused on examining the reasons associated with the difference of each individual physician in the likelihood of signing a do-not-resuscitate order. (shrink)

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)

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

This chapter attempts to explore Huizhao’s theory of svalakṣaṇa and sāmānyalakṣaṇa on the basis of his works, especially his Treatise on Two Means of Valid Knowledge. In this treatise, the main question regarding the nature of cognition in the context of mental cultivation is addressed as such: Is the cognition of universals or the cognition of particulars capable of guiding the practitioner to attain liberation? According to Abhidharmamahāvibhāṣā, universal is the correct answer to the question, since only the path that (...) takes universal as the object is able to eliminate the defilements. For the Chinese Yogācārins and logicians who followed Dignāga, conversely, only the particular can be taken as the object of valid cognition that leads to the final awakening. In the case of Huizhao, he grounds the ontology of universal in the doctrinal framework of Yogācāra idealism, which leads him to compromise between nominalism and conceptualism. This chapter concludes that, as far as the issue of particular and universal is concerned, the Indian side is more devoted to the debate among different philosophical theories, such as realism, nominalism, and conceptualism, whereas on the Chinese side more interests are directed to contextualizing the issue within the practice of cognitive cultivation. (shrink)

This essay focuses on Nishitani Keiji’s 西谷啟治 early and late thinking, in the discourse on world history and modernity during wartime and the postwar meditation on emptiness and historicity in Religion and Nothingness. Following the first part of the analysis, I will trace Nishitani’s critical indebtedness to Heidegger’s existential-phenomenological analysis of historicity in Being and Time, and thereby analyze how Nishitani attempts to solve the aporia of modernity by recourse to the Buddhist doctrine of emptiness. The essay will conclude with (...) some critical remarks that discern the limits and hidden dangers in Nishitani’s philosophical project. (shrink)

This article argues that, as far as the problem of Confucian religiosity is concerned, there is an interpretative turn from Mou Zongsan’s moral metaphysics to Tu Weiming’s religious hermeneutics. Some concluding remarks are made: First, Tu’s hermeneutics is rooted in the ontology of self as interrelatedness, which is completely different from Mou’s theory of true self as transcendental subjectivity. Second, Tu’s hermeneutics of self can be better illuminated with the help of Heidegger’s notion of Dasein as Being-with (Mitsein). For Tu (...) and Heidegger, self cannot be seen as something separate from community. This article also points out that the paradigmatic shift is evidenced in another similarity between the four categories of self, community, nature, and the transcendent in Tu’s hermeneutics on the one hand, and the four symbols of earth, sky, divinities, and mortals employed by Heidegger to interpret the meaning of dwelling, on the other. In such a primordial situation of dwelling, gods are not supposed to be intellectually known; they are rather to be neighbors in community. (shrink)

Most studies have examined the outcomes of patients supported by extracorporeal membrane oxygenation as a life-sustaining treatment. It is unclear whether significant social events are associated with the use of life-sustaining treatment. This study aimed to compare the trend of extracorporeal membrane oxygenation use in Taiwan with that in the world, and to examine the influence of significant social events on the trend of extracorporeal membrane oxygenation use in Taiwan.

Extra-corporeal membrane oxygenation has been introduced to clinical practice for several decades. It is unclear how internet and newspapers portray the use of extra-corporeal membrane oxygenation. This study were: (1) to quantify the coverage of extra-corporeal membrane oxygenation use in newspapers and on the Internet; (2) to describe the characteristics of extra-corporeal membrane oxygenation users presented in newspaper articles and the Internet web pages in comparison with those shown in extra-corporeal membrane oxygenation studies in Taiwan; and (3) to examine the (...) survival rates of extra-corporeal membrane oxygenation users presented in newspaper articles and the Internet web pages in comparison with those in Taiwan and in the Extracorporeal Life Support Registry Report International Summary for January 2014. (shrink)

This paper examines the philosophical debate on Seng Zhao ’s Thesis on No-Motion of Things, a debate which took place approximately at the turn of the late sixteenth and the early seventeenth centuries. Without doubt the Zhao Treatise is the most precious gem in the early Chinese Madhyamaka legacy. The sterling reputation of this seminal treatise had never been challenged until Zhencheng published the Logical Investigation of the Thesis of No-Motion of Things during 1588–1589. The following focuses on Zhencheng’s WBQZLL (...) to see how he applied hetu-vidyā in his hermeneutical project. How did Zhencheng employ the syllogism in his critique of the Zhao Treatise? Is his critique justifiable? How is the role of syllogism employed as a hermeneutic tool to understand classical Buddhist texts? In highlighting the innovative features in the application of hetu-vidyā in the late Ming Chinese Buddhist scholasticism as showcased in Zhencheng’s WBQZLL, The controversies swirling around Zhencheng’s challenge to traditional doctrinal authority reveal the distinctive contrast between two forms of Buddhist hermeneutics in the late Ming Buddhist scholasticism: experiential hermeneutics and analytical hermeneutics. While the former has long been practiced in the mainstream of Chinese Buddhism, the latter has received little attention. (shrink)

In a recent study (Chen et al., 2018), we conducted a series of experiments that induced the “four-hand illusion”: using a head-mounted display (HMD), the participant adopted the experimenter’s first-person perspective (1PP) as if it was his/her own 1PP. The participant saw four hands via the HMD: the experimenter’s two hands from the adopted 1PP and the subject’s own two hands from the adopted third-person perspective (3PP). In the active four-hand condition, the participant tapped his/her index fingers, imitated by (...) the experimenter. Once all four hands acted synchronously and received synchronous tactile stimulations at the same time, many participants felt as if they owned two more hands. In this paper, we argue that there is a philosophical implication of this novel illusion. According to Merleau-Ponty (1945/1962) and Legrand (2010), one can experience one’s own body or body-part either as-object or as-subject but cannot experience it as both simultaneously, i.e., these two experiences are mutually exclusive. Call this view the Experiential Exclusion Thesis. We contend that a key component of the four-hand illusion—the subjective experience of the 1PP-hands that involved both “kinesthetic sense of movement” and “visual sense of movement” (the movement that the participant sees via the HMD)—provides an important counter-example against this thesis. We argue that it is possible for a healthy subject to experience the same body-part both as-subject and as-object simultaneously. Our goal is not to annihilate the distinction between body-as-object and body-as-subject, but to show that it is not as rigid as suggested by the phenomenologists. (shrink)

Multiple versions of the Chinese Remote Associates Test have been developed. Thus far, all CRATs have employed verbal stimuli; other forms of stimuli have not yet been used. In this context, the present study compiled a Chinese Visual Remote Associates Test that conforms to the Chinese language and culture based on a picture naming database. The developed CVRAT has two versions, CVRAT-A and CVRAT-B, each comprising 20 test questions. A typical CVRAT question consists of three stimuli pictures, requiring respondents to (...) propose a target word that is semantically associated with all the pictures. When compiling the CVRAT, this study first selected target words, sifted through stimuli words and corresponding pictures, and analyzed pilot test questions. After compilation, their reliability and validity were examined. The results showed that the CVRAT had moderate internal consistency reliability, good criterion-related validity for the Chinese Word Remote Associates Test, Chinese Radical Remote Associates Test, Chinese Compound Remote Associates Test, insight problem-solving, as well as acceptable discriminant validity for fluency, flexibility, and originality of a divergent thinking test. In other words, CVRAT can effectively measure remote associative capability and provides a figural creativity test that facilitates the understanding of different kinds of remote associations. (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)

Extant literature suggested that executive cognitive ability is a critical perspective to answering why and how enterprises perform business model innovation. However, the effect of executive cognitive ability on business model innovation is still insufficiently explored. Drawing on entrepreneurial bricolage theory, we developed a moderated mediation model which takes entrepreneurial bricolage as the mediating mechanism and environmental dynamics as the moderating mechanism to explain how executive cognitive ability influences business model innovation. We collected the data of 316 executives of Chinese (...) start-ups through questionnaires for the model test. Results showed that new venture executives' cognitive ability significantly positively affects business model innovation by mediating with entrepreneurial bricolage. Environmental dynamism positively moderates the effect of executives' cognitive ability on business model innovation. Moreover, environmental dynamism positively moderates the mediating role of entrepreneurial bricolage in executive cognitive ability and business model innovation. This study broadens the research scope of entrepreneurial bricolage theory from the perspective of cognitive ability and provides ideas for new ventures' business model innovation. (shrink)

Self-location—the sense of where I am in space—provides an experiential anchor for one's interaction with the environment. In the studies of full-body illusions, many researchers have defined self-location solely in terms of body-location—the subjective feeling of where my body is. Although this view is useful, there is an issue regarding whether it can fully accommodate the role of 1PP-location—the sense of where my first-person perspective is located in space. In this study, we investigate self-location by comparing body-location and 1PP-location: using (...) a head-mounted display (HMD) and a stereo camera, the subjects watched their own body standing in front of them and received tactile stimulations. We manipulated their senses of body-location and 1PP-location in three different conditions: the participants standing still (Basic condition), asking them to move forward (Walking condition), and swiftly moving the stereo camera away from their body (Visual condition). In the Walking condition, the participants watched their body moving away from their 1PP. In the Visual condition, the scene seen via the HMD was systematically receding. Our data show that, under different manipulations of movement, the spatial unity between 1PP-location and body-location can be temporarily interrupted. Interestingly, we also observed a “double-body effect.” We further suggest that it is better to consider body-location and 1PP-location as interrelated but distinct factors that jointly support the sense of self-location. (shrink)

Co-creativity focuses on how individuals produce innovative ideas together. As few studies have explored co-creativity using standardized tests, it is difficult to effectively assess the individual’s creativity performance within a group. Therefore, this study aims to develop a platform that allows two individuals to answer creativity tests simultaneously. This platform includes two divergent thinking tasks, the Straw Alternative Uses Test and Bottle Alternative Uses Test, and Chinese Radical Remote Associates Test A and B, which were used to evaluate their open-and (...) closed-ended creative problem-solving performance. This platform has two modes: single-player mode and paired-player mode. Responses from 497 adults were collected, based on which the fluency, flexibility, and originality of divergent thinking were measured. This study also developed a computer scoring technique that can automatically calculate the scores on these creativity tests. The results showed that divergent thinking scores from computer-based calculation and manual scoring were highly positively correlated, suggesting that the scores on a divergent thinking task can be calculated through a system that avoids time-consuming, uneconomical manual scoring. Overall, the two types of tests on this platform showed considerable internal consistency reliability and criterion-related validity. This advanced application facilitates the collection of empirical evidence about co-creativity. (shrink)

The cultural element is the minimum unit of a cultural system. The systematic categorizing, organizing, and retrieval of the traditional Chinese cultural elements are essential prerequisites for the realization of effective extracting and rational utilization, as well as the prerequisite for exploiting the contemporary value of the traditional Chinese culture. To build an objective, integrated, and reliable classification method and a system of traditional Chinese cultural elements, this study takes the text of Taiping Imperial Encyclopedia in Northern Song Dynasty as (...) the primary data source. The unsupervised word segmentation methods are used to detect Out-of-Vocabulary, and then the segmentation results by the THULAC tool with and without custom dictionary are compared. The TF-IDF algorithm is applied to extract the keywords of cultural elements and the Ochiia coefficient is introduced to create complex networks of traditional Chinese cultural elements. After analyzing the topological characteristics of the network, the community detection algorithm is used to identify the topics of cultural elements. Finally, a “Means-Ends” two-dimensional orthogonal classification system is established to categorize the topics. The results showed that the degree distribution in the complex network of Chinese traditional cultural elements is a scale-free network with γ = 2.28. The network shows a structure of community and hierarchy features. The top 12 communities have taken up to 91.77% of the scale of the networks. Those 12 topics of the traditional Chinese cultural elements are circularly distributed in the orthogonal system of cultural elements’ categorization. (shrink)

The growing prevalence of health care ethics consultation (HCEC) services in the U.S. has been accompanied by an increase in calls for accountability and quality assurance, and for the debates surrounding why and how HCEC is evaluated. The objective of this study was to evaluate the effectiveness of HCEC as indicated by several novel outcome measurements in East Asian medical encounters.

In this paper I test major analytic theories of interpretation, including anti-intentionalism, the value-maximizing theory, actual intentionalism, and hypothetical intentionalism, against Li Shang-yin’s poem ‘The Ornamented Zither’. I argue that, based on the results of the test, all of these theories face grave difficulties. If their supporters want their accounts to be sustained in the debate over interpretation, they need to address the worries I raise.

Urban streetscapes are outdoor areas in which the general public can appreciate green landscapes and engage in outdoor activities along the street. This study tested the extent to which the degree of awareness of urban street trees impacts attention restoration and perceived restorativeness. We manipulated the degree of awareness of street trees. Participants were placed into four groups and shown different images: (a) streetscapes with absolutely no trees; (b) streetscapes with flashes of trees in which participants had minimal awareness of (...) the content; (c) streetscapes with trees; and (d) streetscapes with trees to which participants were told to pay attention. We compared the performance of 138 individuals on measures of attention and their evaluations of perceived restorativeness. Two main findings emerged. First, streetscapes with trees improved the performance of participants on attentional tests even without their awareness of the trees. Second, participants who had raised awareness of street trees performed best on the attentional test and rated the streetscapes as being more restorative. These findings enhance our knowledge about the role of an individual's awareness of restorative elements and have implications for designers and individuals who are at risk of attentional fatigue. (shrink)

The utterance model is a popular basis for theories of interpretation in the contemporary analytic philosophy of literature. This model suggests that interpretation should be constrained by a work's identity‐relevant factors in its context of production because a work, like an utterance, acquires its identity and content in part from its relations with that context. From a descriptive point of view, I argue that the implied author account of interpretation best describes critical practice following the current positions based on the (...) utterance model. That is, people who interpret in accordance with these positions end up interpreting an implied author. (shrink)

The American Journal of Bioethics, Volume 11, Issue 8, Page 58-59, August 2011.

This paper defends a Hackingian approach to the scientific realism debate by arguing against mainstream realists’ and antirealists’ common claim that no experimental arguments for the reality of posited entities can be theory-independent. Opposing this claim, I argue that some experimental arguments can warrant belief in the existence of entities without depending on the truth of the theories that posit the entities and describe their properties and the theories that explain the interactions between the entities and the experimental devices. To (...) achieve this goal, I investigate Hacking’s case of electron spraying, the famous experiment of positioning atoms by means of a scanning tunnelling microscope, and some novel experiments that use Ashkin’s optical tweezers. By introducing the distinction between theoretical properties and ontic properties, I argue that we can build up some theory-independent criteria of reality on the basis of ontic properties. Manipulability is an ontic property and the manipulation criterion is thus a theory-independent one, which should be reexamined and used for those experimental cases along a local approach to the realism debate. Resisting the mainstream realists’ and antirealists’ objections, I contend that some experiments using optical tweezers can warrant belief in the existence of the experimented entities without depending on theories. (shrink)

In this paper, we analyze how citizens evaluate their president, especially focusing on why voters lower their evaluations at an individual-level perspective. We assert that citizens raise their evaluations of a new president when their expectations are met and lower their opinions when his or her performance disappoints them. Furthermore, the evaluations of the president are not only affected by a government's economic and diplomatic performance, but are also influenced by individual awareness of salient political issues, the contents of the (...) news, and their own perceived influence on politics. We test the theoretical hypotheses using Taiwan's Election and Democratization Study panel survey data. The statistical results support our theoretical hypotheses and show that when President Ma's performance did not meet respondents media exposure and political efficacy are significantly associated with the change in their opinions of Ma. (shrink)

Some theorists on literary interpretation have suggested a connection between Monroe C. Beardsley’s anti-intentionalism and hypothetical intentionalism based on an implied author. However, a full exploration has never been attempted. I undertake this task in this paper. A close reading of Beardsley reveals that he assumes something very similar to the implied author in interpretation. I distinguish five types of fictional works in terms of their narrative mode and show that my claim stands in at least four of the five (...) types. The significance of my argument lies in exposing the above version of authorism in anti-intentionalism. -/- Beardsley is generally perceived as advocating the irrelevance of authorial intention to literary interpretation. The common interpretation of his theory is that work-meaning is generated by linguistic conventions, with intention playing no role in meaning-determination. All the interpreter needs is knowledge of public, linguistic conventions in order to recover textual meaning. -/- Nevertheless, when dealing with the problem of interpretation, Beardsley explicitly talks about attributing textual meaning to a fictional speaker. Although he does not elaborate on the nature of this speaker, clues scattered in his writings point to the striking similarity of this theoretical apparatus to an implied author. The key lies in his presumption that every fictional work must have an ultimate speaker to whom meaning inferred from the text should be attributed. This claim is almost the core of an implied author theory of interpretation. -/- A difficulty in classifying Beardsley’s view as a version of the implied author position is that his characterization of the story’s presenter might apply better to the story’s narrator than to its implied author. To test this, I examine different types of narrative modes to see whether the fictional speaker merges with the implied author in each of these scenarios. -/- The first factor to consider for classifying narrative modes is whether the narrator’s presence is explicit or implicit. The narrative scenario in which the narrator is implicit can be further divided into two sub-types: either the story is told from an omniscient viewpoint or centers on the experience of a third-person character. In either case, the story is not told by any of the characters in the story; rather, it is told by an implicit speaker whose words the work purports to be. It seems reasonable to identify this fictional speaker with the implied author, for both function as the subject to which textual meaning is attributed. -/- As for the narrative mode in which the narrator is explicit, this involves first-person narratives. In these, either the narrator is reliable or unreliable. When the narrator is unreliable, a transcendental perspective is required in determining the text’s meaning, because what is said ultimately in the work is not equivalent to what is literally said by the unreliable narrator. It follows that an implicit speaker has to be assumed and she again coincides with the implied author. -/- Where the narrator is reliable but textual meaning transcends what is literally expressed, an implicit speaker is at play again. This narrative scenario is thus better classified as a case in which the narrator’s presence is implicit. This leaves us with the narrative scenario in which the narrator is a reliable spokesperson for the implied author. -/- The identification of the narrator with the implied author in the case last mentioned is controversial. The crucial difference between them is that the former is dramatized in the story while the latter is not. I accept that the narrator here is not happily called an implied author, though I also point out several similarities between the two. -/- Finally, I discuss four complications to my argument. The first concerns multiple points of view in a story. To accommodate this kind of narrative, Beardsley could argue that an implicit narrator is needed to explain the definite meaning concealed behind what is literally said by different characters. The second complication is about the ontological status accorded to the narrator and the implied author. It might be objected that the two reside in different fictional worlds and this is what makes their merging impossible. But it is questionable whether this is a definitional feature of the implied author; moreover, the interpreter can take the implied author to be an instrumentalist concept and hence avoid talk about the ontological status of fictional entities. The third complication claims that versions of the implied author position developed by philosophers tend to be based on a contextualist ontology of literature; however, Beardsley’s account is acontextual. This is not true, for Beardsley has exhibited contextualist leanings in his writings. Finally, it has been objected that the formalist resources Beardsley has are not enough to guarantee a single right interpretation. But if Beardsley is actually a contextualist, contextual constraints will come into play and raise the chance of getting a single right interpretation. -/- The article concludes by reflecting on the significance of the misrepresentation of anti-intentionalism: it is the intention of the actual author which anti-intentionalism is against. The position in question is actually developed in an intentionalist framework based on the implied author. (shrink)