Understanding the effect of computer-supported, case-based instruction on third-year medical students' ethical reasoning

The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file.Title from title screen of research.pdf file (viewed on February 20, 2008)Vita.Thesis (Ph. D.) University of Missouri-Columbia 2007.The major focus of this study was to determine whether or not providing third-year medical students with example videos that exhibit experts' ethical reasoning and with opportunities to engage in online asynchronous ethical case discussions would stimulate change and improvement in students' ethical reasoning. It was speculated that the medical students would be able to reflect on both their own reasoning and others' reasoning and thus develop complexity in how they reason. In this study ethical reasoning consisted of four components: (1) identification of ethical issues (ethical sensitivity); (2) adoption of multiple viewpoints (ethical viewpoint); (3) resolution of ethical dilemmas (ethical options); and, (4) justification of decisions and actions (ethical justification). In addition to examining the effectiveness of the instructional activities, the impact of the ethics curriculum on students' perception of the relevance and effectiveness of medical ethics teaching on their ability to handle ethical issues in daily clinical practice was also examined. Finally, another aim of this study was to understand how medical students interacted with their peers during online asynchronous ethical case discussions. ANOVA results did not show any significant difference between the computer-supported, case-based (CSCB) instruction and non computer-supported, case-based (non-CSCB) instruction groups on the four sub-scores (ethical sensitivity, ethical viewpoint, ethical options, and ethical justification) from the pre-test to post-test. Results revealed, however, a significant increase on participants' perception of their ability to deal with ethical issues in clinical settings after the ethics curriculum in the Internal Medicine clerkship rotation. Two levels of content analyses using pre-determined coding schemes were applied in order to identify interaction patterns in the online asynchronous ethical case discussions.Includes bibliographical reference

DESIGNING A SERVICE PORTFOLIO FOR A TAIWANESE HOSPITAL TELECARE CENTER

National Ministry of Health and Welfare defined Tele health care (Telecare) as a combination of medical care, ICT technology, electronic medical equipment, and other cross-cutting professional to allow people to get the health care and preventive health services in the community and familiar home environment and aging in place. To date, telecare has become the world medical technology and services industry trend. However, most elderly are significantly less familiar with technology use than the general population, inhibiting telecare adoption. Based on service portfolio concept, we design core and supplementary service elements for a Taiwanese telecare center. To further examine how patients perceive the values of these service elements in different adoption stages, we conduct surveys with potential clients and current patients of the telecare center. We take customers adoption process as an indicator of “value creation” and examine how the values of service elements vary across different adoption stages. Meanwhile, service quality and productivity should be properly integrated since quality focuses on the benefits created for the customer’s side of the equation, but productivity addresses the financial costs incurred by the hospital. If not properly integrated, these two foci can be in conflict. Thus, our service portfolio will consider not only the value of the services but also the available management resources to run the services. The results suggest approaches to re-allocating the limited resource to the most valuable service elements perceived by customers, and thus help hospitals to drive potential clients, sustain current patients, and maintain service quality of the hospital simultaneously

Psychosocial Determinants of Insomnia in Adolescents: Roles of Mental Health, Behavioral Health, and Social Environment

The theoretical explanation of human problems is derived from the complex interplay of psychological, social, economic, political, and physical factors. Aims: This study examined the roles of behavioral health (i.e., alcohol abuse and suicidality) and social environment (i.e., family support, school connectedness, and favorable neighborhood) and mental health [i.e., depression, anxiety, and attention deficit hyperactivity disorder (ADHD)] in predicting insomnia in adolescents in an ecological perspective. Methods: Approximately 6445 high school students in Taiwan were administered an anonymous self-report survey. Hierarchical multiple regression was performed to examine how multidimensional social environment, behavioral health, and mental health factors were associated with insomnia in adolescents. Results: The prevalence rate of insomnia in the sample was 30%. The results indicated that alcohol abuse (β = 0.04), suicidality (β = 0.06), depression (β = 0.29), anxiety (β = 0.14), and ADHD (β = 0.11) were positively associated with insomnia (p \u3c 0.001), whereas family support (β = −0.06), school connectedness (β = −0.05), and favorable neighborhood (β = −0.10) were negatively associated with insomnia (p \u3c 0.001). Sex did not predict insomnia, but age was positively associated with insomnia (β = 0.09, p \u3c 0.001). Among all predictors of insomnia in the study, mental health factors, especially depression, play a major role on insomnia among adolescents, and is as much important as social environment factors. Conclusion: This study demonstrated how both psychosocial variables (social environment and behavioral health) and psychological symptoms were associated with insomnia in adolescents when the demographic variables (sex and age) were controlled and provided valuable information and evidence for clinicians, social workers, and health professionals who provide support to adolescents with insomnia. Applying an ecological approach in practice can aid in understanding at individual, family, school, and community levels and in identifying the strengths and weaknesses of their interactions with each other. Implications: This perspective enables practitioners in effectively treating problems and addressing the needs of the various levels, including the individual, family, school, and the broader community. Thus, prevention and intervention of insomnia in adolescents should focus on multidimensional risk and protective factors, including mental health, behavioral health, and social environment, in the context of an ecological system

Drivers of eHealth Adoption: Linking eHealth Adoption to Service Concept

Researchers and practitioners are keenly interested in understanding what drives eHealth adoption in recent years. This is largely because, while eHealth can lead to cost-effective and quality health care, the actual adoption rate of eHealth remains low across countries. In prior literature, it was clearly indicated that well-designed eHealth services are critical to eHealth adoption. In this study, our findings further show that, what may motivate patients’ adoption is more strongly associated with the design of eHealth caring service, and the design of eHealth IT service is more likely to be associated with patients’ continual use

CUSTOMER READINESS, MARKET ORIENTATION AND TRANSACTION FREQUENCY IN MOBILE BANKING SERVICE RECOVERY

This study investigates the effect of internet banking service recovery satisfaction on future intention toward using mobile banking, and examines transaction frequency as a moderator of this relationship. Moreover, this study applies customer participation in service recovery and service recovery experience as the influential factors of service recovery satisfaction. Questionnaires were obtained 419 respondents with internet banking and service recovery experience. The results of SEM analysis illustrate that both role clarity and ability of service recovery can affect the level of service recovery participation. Additionally, the internet banking service provider’s responsive and proactive customer orientation can influence customer service recovery experience, which further increases service recovery satisfaction. Recovery satisfaction can thus affect future intention toward using mobile banking. The moderating effect of transaction frequency was also confirmed. Theoretical and managerial implications are discussed

Maintaining CD4/CD8 ratio and Th1-CTL subsets of chimeric antigen receptor (CAR)-T cells in serum-free culture conditions

Chimeric antigen receptor (CAR) T cells therapy is a promising strategy that significantly controlled the progress of cancer diseases. CAR-T cells could kill cancer cells through cellular immune response; therefore, CD8+ cytotoxic T cells are critical for CAR-T cell therapy. However, recent papers reported that CD4+ T helper cells were important for the response and maintenance of CAR-T cells in vivo. Here, we developed a serum-free CAR-T cell preparation process that maintained the T cell population and controlled the T cell subsets. The CD4+ and CD8+ T cell population in CAR-T cells were maintained at averagely 59.4 % and 34.6%, and the major T cell subsets were Th1 cells and cytotoxic T lymphocytes (CTLs), implying the potentially high cellular immune response. To verifying whether the prepared CAR-T cells were exhausted, the expression of several immune checkpoint markers was determined. Of interest, only less than 20% of CAR-T cells at endpoint were PD-1+ or CTLA4+, but more than 40% of CAR-T cells at the endpoint were TIM-3+, implying most CAR-T cells were not exhausted. These CAR-T cells produced more than 1 ng/mL of IFN-γ in the response to the antigen. Altogether, CAR-T cells could be prepared in our serum-free process in the controlling of T cell subsets, leading to potential high therapeutic potency. Please click Additional Files below to see the full abstract

In vitro high expansion of chimeric antigen receptor (CAR)-T cells in serum-free process conditions

Manufacturing process is an important and complex factor for preparing chimeric antigen receptor (CAR) T cells for therapy. Although serum was widely applied in the culture or expansion of T cells, the quality of serum could be varied from batch to batch, leading to the variation of T cell expansion and quality. In addition, the safety of pathogens from serum and Chemistry, Manufacturing, and Control (CMC) were required to be considered. To overcome the disadvantages of serum application in T cell culture, serum-free and xeno-free culture conditions were required. We intended to develop a rapid serum-free culture condition for the expansion of immune T cells ex vivo. In our optimized serum-free condition, CAR-T cells could be expanded to about 100-200 times to the initial cell number after 6-day culture and the cell viability of all specimens was above 98%. Of interest, the percentage of CAR+ population in all specimens was increases, and the T cell pollutions could be maintained at averagely about 35-40% of CD8+ T cells and averagely about 50-55% of CD4+ T cells after culture. Taken together, our conditions could be applied in the expansion of CAR-T cells for cell therapy to support the minimum requirement of blood or cell samples from patients and to maintain the T cell population. Please click Additional Files below to see the full abstract

Enhancing crispr-mediated CHO cell antibody productivity through concentrated fed- batch or continuous perfusion

Integrated continuous bioprocessing technology has high productivity and cost saving benefit, which combines the upstream (Cell culture) and downstream (Purification) processing. The continuous bioprocessing based biopharmaceutical manufacturing is more profitable than traditional batch/fed-batch processing in increasing quality and quantity. The goal of this study focuses on the upstream continuous process development with crispr-mediated targeted gene integration CHO cell line producing monoclonal antibody. In the upstream processing, we developed concentrated fed-batch culture (CFB) and high density perfusion culture in 2-5 L bioreactor with a cell retention device (alternating tangential flow, ATF). With our concentrated fed-batch culture system, the VCD achieved 8.4x107 cells/m in 11days operation with 1VVD producing antibody 3.3-fold that of fed-batch culture system; in the high density perfusion culture system, the VCD achieved 5x107 cells/ml in 28 days operation with 1 VVD producing antibody greater than 1g/L/day with on the Day10 and keep the cell density, viability and productivity more than 1 month

The influence of longitudinal mentoring on medical student selection of primary care residencies

Background The number of students selecting careers in primary care has declined by 41% in the last decade, resulting in anticipated shortages. Methods First-year medical students interested in primary care were paired with primary care mentors. Mentors were trained, and mentors and students participated in focus groups at the end of each academic year. Quantitative and qualitative results are presented. Results Students who remained in the mentoring program matched to primary care programs at 87.5% in the first year and 78.9% in the second year, compared to overall discipline-specific match rates of 55.8% and 35.9% respectively. Students reported a better understanding of primary care and appreciated a relationship with a mentor. Conclusions A longitudinal mentoring program can effectively support student interest in primary care if it focuses on the needs of the students and is supportive of the mentors

Application of Data Mining Algorithm to Recipient of Motorcycle Installment

The study was conducted in the subsidiaries that provide services of finance related to the purchase of a motorcycle on credit. At the time of applying, consumers enter their personal data. Based on the personal data, it will be known whether the consumer credit data is approved or rejected. From 224 consumer data obtained, it is known that the number of consumers whose applications are approved is 87% or about 217 consumers and consumers whose application is rejected is 16% or as much as 6 consumers. Acceptance of motorcycle financing on credit by using the method of applying the algorithm through CRIS-P DM is the industry standard in the processing of data mining. The algorithm used in the decision making is the algorithm C4.5. The results obtained previously, the level of accuracy is measured with the Confusion Matrix and Receiver Operating characteristic (ROC). Evaluation of the Confusion Matrix is intended to seek the value of accuracy, precision value, and the value of recall data. While the Receiver Operating Characteristic (ROC) is used to find data tables and comparison Area Under Curve (AUC)