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Transcranial direct current stimulation has been widely utilized in research settings and modulates brain activity. The application of anodal tDCS on the prefrontal cortex has indicated improvement in cognitive functioning. The cingulate cortex, situated in the medial aspect of the prefrontal cortex, has been identified as a core region performing cognitive functions. Most of the previous studies investigating the impact of stimulation on the prefrontal cortex stimulated the dorsolateral prefrontal cortex, however, the impact of stimulation on cingulate has not been (...) explored. The current study investigates the effect of stimulation on the resting-state functional connectivity of the anterior cingulate cortex with other regions of the brain and changes in behavioral results in a color-word Stroop task, which has repeatedly elicited activation in different regions of the cingulate. Twenty subjects were randomly assigned to the experimental and sham group, and their medial prefrontal area was stimulated using MRI compatible tDCS. Resting-state functional magnetic resonance imaging and cognitive Stroop task were monitored before, during, and after the stimulation. Neuroimaging results indicated a significant decrease in resting-state functional connectivity in the experimental group during and after stimulation as compared to before stimulation in two clusters including right insular cortex, right central operculum cortex, right frontal operculum cortex and right planum polare with the left anterior cingulate cortex selected as the seed. The behavioral results indicated a significant decrease in reaction time following stimulation in the experimental group compared to the sham group. Moreover, the change in functional connectivity in subcortical regions with L-ACC as the seed and change in RT was positively correlated. The results demonstrated that ACC has a close functional relationship with the subcortical regions, and stimulation of ACC can modulate these connections, which subsequently improves behavioral performance, thus, providing another potential target of stimulation for cognitive enhancement.Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT04318522. (shrink)

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This paper evaluates the Hong Kong approach to consent regarding the forgoing of life-sustaining treatment for incompetent elderly patients. It analyzes the contextualized approach in the Hong Kong process-based, consensus-building model, in contrast to other role-based models which emphasize the establishment of a system of formal laws and a clear locus of decisional authority.Without embracing relativism, the paper argues that the Hong Kong model offers an instructive example of how strategic ambiguities can both make good sense within particular cultural context (...) and serve important moral goals. (shrink)

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

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With the worldwide spread of the Internet, human activity has become permeated by digital media, which shapes communication and interaction and speeds up the improvement of the experience and diffusion of museum exhibitions. Contemporary museums must understand their audiences, especially with respect to online preferences and surfing involvement experiences. Museums are changing in an effort to attract young netizens to access and use museum resources. Virtual museums are increasingly using digital exhibitions to preserve and apply their collections and establishing online (...) community platforms to interact with young people. This study investigates the underlying mechanism of online community characteristics that enhance audiences’ emotional resonance and involvement. Results from a questionnaire survey of Taiwan undergraduate students show that perceived relevance and esteem improve their emotional resonance, which can attract new people and maintain existing relationships within their communities. Following flow theory, maintaining community relationship characteristics increases emotional resonance, which, in turn, enhances user involvement, but we found only small significant effects of emotional resonance on involvement. These findings illuminate the mechanism of the attitudinal relationship building and maintenance for online museum communities and advance the practical contributions of online museum community use and effects. (shrink)

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The study analyzes the influential factors of consumers’ willingness to purchase gray-market smartphones by considering the model of novelty seeking, status consumption, integrity, and perceived risk. Attitude toward counterfeit is used as mediation in the model. The causalities in the model of problematic willingness of consumer to purchase gray-market smartphones are hypothesized. A total sample of 350 respondents with 238 effective samples is collected by interviewing with questionnaires at the service counters of telecommunications operators. Structure equation modeling (SEM) is adopted (...) in the analysis. Consumers’ attitude toward counterfeit goods is found to be positively related to the willingness of consumers to purchase gray-market smartphones, but perceived risk is negatively related to consumers’ willingness to purchase. As for personality constructs, integrity and status consumption are found to be negatively related to consumers’ attitude toward counterfeit goods, but novelty seeking is positively related to the attitude. Further, managerial implications for branded smartphone manufacturers and telecommunications regulators are provided by the research. (shrink)

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Based on the expanded theory of planned behavior, this study first explores the configuration relationship between founder management and innovation by using the fuzzy-set qualitative comparative analysis. Based on the theory of planned behavior, this study divides the behavior intention of founders into three categories: Attitude, subjective norm, and perceived behavior control. Using fsQCA, we found that there are two ways to achieve high innovation input of enterprises. In combination with the two ways, the factors such as male and highly (...) educated founder, and large firm size can effectively increase the innovation input of firms, which is consistent with the three aspects of the behavioral intention of the theory of planned behavior, and it proves that the theory of planned behavior can effectively explain the configuration relation between the founder and firm innovation. In addition, this study finds that the innovation output is different from the innovation input, is dependent on the innovation ability of the firm itself, and is less influenced by the external environment. (shrink)

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With the continuous progress and penetration of automated data collection technology, enterprises and organizations are facing the problem of information overload. The demand for expertise in data mining and analysis is increasing. Self-efficacy is a pivotal construct that is significantly related to willingness and ability to perform a particular task. Thus, the objective of this study is to develop an instrument for assessing self-efficacy in data mining and analysis. An initial measurement list was developed based on the skills and abilities (...) about executing data mining and analysis, and expert recommendations. A useful sample of 103 university students completed the online survey questionnaire. A 19-item four-factor model was extracted by exploratory factor analysis. Using the partial least squares-structural equation modeling technique, the model was cross-examined. The instrument showed satisfactory reliability and validity. The proposed instrument will be of value to researchers and practitioners in evaluating an individual’s abilities and readiness in executing data mining and analysis. (shrink)

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This study applies the concept of reported speech advanced by the renowned Russian literary scholar Mikhail Bakhtin to compare the argumentative styles of Mainland China and Taiwan. These societies in question are considered by many scholars as sharing the same argumentative style. The study reports that the Mainland debaters more frequently than the Taiwanese debaters maintained the authenticity of the quotations cited from ancient Confucian sources, whereas Taiwanese debaters paraphrased more frequently. On the other hand, this difference cannot be found (...) when debaters quoted from sources other than Ancient Confucians. The findings, according to Bakhtin, imply a contrast of monologic and dialogic tendencies toward authority, which results in a style difference between Mainland and Taiwan argumentation. (shrink)

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This study examines the effects of leader emotional intelligence, leadership styles, organizational commitment, and trust on job performance. A questionnaire was administered to the participants, who were real estate brokers in Kaohsiung City. Of the 980 questionnaires administered, 348 valid responses were received, indicating an effective response rate of 35.5%. Structural equation modeling was used for the analysis. The results show that leader emotional intelligence has a significant and positive effect on trust in supervisors, and transformational leadership and trust within (...) a team have significant and positive effects on job performance. In addition, organizational commitment has a significant and positive effect on job performance. Trust within a team mediates the significant and positive effect of leader emotional intelligence on job performance. Although transactional leadership has no direct, positive, and significant effects on employee job performance, trust in the workplace shaped by a leader’s leadership style will empower a team’s spirit and boost their morale, thereby indirectly affecting their job performance in a positive manner. (shrink)

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Pain has not only sensory, but also emotional and cognitive, components. Some studies have explored the effect of pain on time perception, but the results remain controversial. Whether individual pain-related emotional and cognitive factors play roles in this process should also be explored. In this study, we investigated the effect of electrical stimulation–induced pain on interval timing using a temporal bisection task. During each task session, subjects received one of five types of stimulation randomly: no stimulus and 100 and 300 (...) ms of non-painful and painful stimulation. Pain-related emotional and cognitive factors were measured using a series of questionnaires. The proportion of “long” judgments of a 1,200-ms visual stimulus duration was significantly smaller with 300 ms painful stimulation than with no stimulus and 100 ms and 300 ms non-painful stimulation. The point of subjective equality did not differ among sessions, but the average Weber fraction was higher for painful sessions than for no-stimulus session. The pain fear score correlated positively with the PSE under 100 ms non-painful and painful and 300 ms painful stimulation. Pain catastrophizing and pain anxiety scores correlated significantly with the WF under no stimulus and 100 ms non-painful stimulation, respectively. These results suggest that electrical stimulation–induced pain affects temporal sensitivity, and that pain-related emotional and cognitive factors are associated with the processing of time perception. (shrink)

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Exploring the amplitude modulation phenomenon of chaotic signal has become a subject of great concern in recent years. This paper mainly concentrates on the preliminary study on amplitude modulation principle of a chaotic system. First, two 3D chaotic systems with quadratic product terms are introduced for studying the amplitude modulation phenomenon of chaotic signal. It is found that the signal amplitude of the first system can be controlled by partial quadratic coefficient. But for the second system, none of nonlinear coefficient (...) can be employed to control the signal amplitude. Then, the amplitude modulation principle of chaotic system is preliminarily studied by exploring the intrinsic relationship between nonzero equilibrium point and phase space trajectory, and it is further validated by introducing unified parameter to the two 3D chaotic systems. As a necessary condition, the principle provides a feasible and simple method for constructing and analyzing an amplitude modulation chaotic system. (shrink)

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Background: Burnout is a stress-induced syndrome considered to be closely related to work. Although social support could relief burnout syndrome, its effect on learning burnout in medical students remains unclear. The objectives of the study are to evaluate the association between learning burnout and social support in Chinese medical students.Methods: A cross-sectional online survey was distributed to students who participated in online learning in a medical college in Wuhan during the COVID-19 epidemic. We used the Lian version of the Maslach (...) Burnout Inventory to assess learning burnout and the Social Support Rating Scale to assess social support. Chi-square tests were used to analyze factors associated with burnout. Independent t-test and multiple logistic regression were explored to analyze the relationship between social support and burnout.Results: A total of 684 students have completed the survey, of which 315 met standard criteria for learning burnout. Multiple logistic regression analysis has revealed that seniors, low family income and low social support were significant predictors of learning burnout. After adjusting for the grade and family income, there was a significant and relevant association between social support and learning burnout.Conclusions: Learning burnout was highly prevalent in medical students at our college. Senior students and low family income might be risk factors for learning burnout. Social support, especially subjective support and utilization of support might play a protective role in reducing the risk of learning burnout. (shrink)

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Includes translations of the important manuscripts in silk found at the famous Mawangdui Tomb in 1973.

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Background This study used a scenario- and discussion-based approach to teach preclinical medical students the socio-philosophical aspects of psychiatry and qualitatively evaluated the learning outcomes in a medical humanities course in Taiwan. Methods The seminar session focused on three hypothetical psychiatry cases. Students discussed the cases in groups and were guided by facilitators from multiple disciplines and professions. At the end of the semester, students submitted a narrative report comprising their reflections on the cases and discussions. The authors utilized content (...) analysis to categorize students’ narratives into three facets, namely, the philosophical, social and individual. Results In total 163 preclinical medical students participated in the class; 150 of them mentioned the scenario-based lesson in their reports; 33.3% of these reports discussed the case at the philosophical dimension (n = 50), 45.3% at the social dimension (n = 68), and 26.6% at the individual dimension (n = 40). Four major themes emerged: (1) a psychiatric diagnosis has far-reaching consequences for an individual’s life, (2) the social structure affects how patients experience psychiatric disorders, (3) students related personal experience or those of friends and family to understand psychiatric disorders, and (4) medical humanities are of particular importance in psychiatric education. Conclusions This study demonstrated that the scenario-based discussions led by a multidisciplinary team of facilitators can benefit medical students with limited clinical experience to contemplate the socio-philosophical aspects of psychiatry. The authors suggest that this pedagogical model during preclinical education should be encouraged. (shrink)

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Respect for patient autonomy is paramount in resolving ethical tensions in end-of-life care. The concept of relational autonomy has contributed to this debate; however, scholars often use this concept in a fragmented manner. This leads to partial answers on ascertaining patients’ true wishes, meaningfully engaging patients’ significant others, balancing interests among patients and significant others, and determining clinicians’ obligations to change patients’ unconventional convictions to enhance patient autonomy. A satisfactory solution based on relational autonomy must incorporate patients’ competence (apart from (...) decisional capacity), authenticity (their true desires or beliefs) and the involvement level of their significant others. To that end, we argue that John Christman’s procedural approach to relational autonomy provides critical insights, such as the diachronic or socio-historical personhood, sustained critical reflection and his recent explication of the nature of asymmetrical relationships and helpful interlocutors. This study reviews Christman’s account, proposes minor modifications and advocates for an integrated three-dimensional model for medical decision-making. Clarifying the relationship among the three elements promotes an ethical framework with a coherent understanding of relational autonomy. This model not only provides a descriptive and normative framework for end-of-life care practice but also reconsiders the nature of the clinician–patient relationship and its normative implications. We further present a case study to illustrate the merits of our proposed model. Altogether, our proposal will help navigate complex medical decision-making, foster trust and negotiate shared values between patients and their significant others, particularly in end-of-life care. (shrink)

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ObjectiveAs the coronavirus disease 2019 pandemic spread across Shanghai, China, in late February 2022 and protective measures to mitigate its impact were enacted, this study aimed to estimate how home quarantine affected the mental health of preschool children in Shanghai, China and explore the association between lifestyle factors and mental health during this special period.MethodsA cross-sectional online survey of 2,110 preschool students from Shanghai, China, was conducted during May 20–25,2022. Preschooler’ mental health and daily activities were reported by parents.ResultsThe sample (...) involved 2,110 children with a mean age of 4.65 years [standard deviation : 0.91, range: 3–6 years]. Boys and children whose mother’s education level were college and high school had higher rate of mental health problems. Boys had significantly higher rates of peer problems and prosocial behaviors than girls. The 3-year-old group had significantly higher rates of prosocial behaviors than other groups. As compared to the Shanghai norm and the SDQ results of preschool children in Shanghai in 2019, there were a significant decrease in emotional symptoms score, as well as a significant increase in conduct problems score. Additionally, peer problems score significantly increased compared to SH2019. Decreased time spent on daily sleep was associated with the increased risk for preschoolers’ mental health problems.ConclusionThere was an increase in the frequency of emotional and behavioral problems, especially regarding conduct problems and peer problems, in preschool children during the COVID-19 home quarantine in Shanghai, China. Boys, younger preschool children and children whose mother’s education level were college and high school may be especially vulnerable to emotional and behavioral problems. It was also found that decreased time spent on sleep may aggravate preschool children’s mental health problems. It may be beneficial to differentiate and focus on conducting psychoeducation and implementing psycho-behavioral interventions to solve these issues. (shrink)

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