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This chapter examines Qiu Jun’s eclectic vision of employing military violence in the rule of the imperial realm. As a well-established Classicist, Qiu deeply immersed himself in the ancient doctrines of guiding the monarch to practice the kingly way that equipped him with benevolence and righteousness, which would translate moral power into invincible military might. Moral value thus outweighed the martial one. The reality, however, taught Qiu the necessity of military preparation and using coercive means when dealing with external and internal security issues. Qiu therefore sought a way to reconcile both moral and military values. Moral principles, according to Qiu, would also legitimatize the use of military violence. Furthermore, to strengthen the military capability of the Ming Empire, Qiu also looked for intellectual resources from historical precedents to model the institutional reforms that he advocated, regardlessof the fact that the ancient practices might not fit the current circumstances.
Patients with schizophrenia have a significantly elevated risk of mortality. Clozapine is effective for treatment-resistant schizophrenia, but its use is limited by side-effects. Understanding its association with mortality risk is crucial.
Aims
To investigate the associations of clozapine with all-cause and cause-specific mortality risk in schizophrenia patients.
Method
In this 18-year population-based cohort study, we retrieved electronic health records of schizophrenia patients from all public hospitals in Hong Kong. Clozapine users (ClozUs) comprised schizophrenia patients who initiated clozapine treatment between 2003 and 2012, with the index date set at clozapine initiation. Comparators were non-clozapine antipsychotic users (Non-ClozUs) with the same diagnosis who had never received a clozapine prescription. They were 1:2 propensity score matched with demographic characteristics and physical and psychiatric comorbidities. ClozUs were further defined according to continuation of clozapine use and co-prescription of other antipsychotics (polypharmacy). Accelerated failure time (AFT) models were used to estimate the risk of all-cause and cause-specific mortality (i.e. suicide, cardiovascular disease, infection and cancer).
Results
This study included 9,456 individuals (mean (s.d.) age at the index date: 39.13 (12.92) years; 50.73% females; median (interquartile range) follow-up time: 12.37 (9.78–15.22) years), with 2020 continuous ClozUs, 1132 discontinuous ClozUs, 4326 continuous non-ClozUs and 1978 discontinuous Non-ClozUs. Results from adjusted AFT models showed that continuous ClozUs had a lower risk of suicide mortality (acceleration factor 3.01; 99% CI: 1.41–6.44) compared with continuous Non-ClozUs. Continuous ClozUs with co-prescription of other antipsychotics exhibited lower risks of suicide mortality (acceleration factor 3.67; 1.41–9.60) and all-cause mortality (acceleration factor 1.42; 1.07–1.88) compared with continuous Non-ClozUs. No associations were found between clozapine and other cause-specific mortalities.
Conclusions
These results add to the existing evidence on the effectiveness of clozapine, particularly its anti-suicide effects, and emphasise the need for continuous clozapine use for suitable patients and the possible benefit of clozapine polypharmacy.
The Hawkes process is a popular candidate for researchers to model phenomena that exhibit a self-exciting nature. The classical Hawkes process assumes the excitation kernel takes an exponential form, thus suggesting that the peak excitation effect of an event is immediate and the excitation effect decays towards 0 exponentially. While the assumption of an exponential kernel makes it convenient for studying the asymptotic properties of the Hawkes process, it can be restrictive and unrealistic for modelling purposes. A variation on the classical Hawkes process is proposed where the exponential assumption on the kernel is replaced by integrability and smoothness type conditions. However, it is substantially more difficult to conduct asymptotic analysis under this setup since the intensity process is non-Markovian when the excitation kernel is non-exponential, rendering techniques for studying the asymptotics of Markov processes inappropriate. By considering the Hawkes process with a general excitation kernel as a stationary Poisson cluster process, the intensity process is shown to be ergodic. Furthermore, a parametric setup is considered, under which, by utilising the recently established ergodic property of the intensity process, consistency of the maximum likelihood estimator is demonstrated.
Görtler vortices induced by concave curvature in supersonic turbulent flows are investigated using resolvent analysis and large-eddy simulations at Mach 2.95 and Reynolds number $ Re_{\delta }=63\,500$ based on the boundary-layer thickness $ \delta$. Resolvent analysis reveals that the most amplified coherent structures manifest as streamwise counter-rotating vortices with optimal spanwise wavelength $ 2.4\delta$ at cut-off frequency $f\delta /{u}_{\infty } =0.036$, where $ {u}_{\infty }$ is the freestream velocity. The leading spectral proper orthogonal decomposition modes with spanwise wavelength approximately $ 2\delta$ align well with the predicted coherent structures from resolvent analysis at $f\delta /{u}_{\infty } =0.036$. These predicted and extracted coherent structures are identified as Görtler vortices, driven by the Görtler instability. The preferential spanwise scale of the Görtler vortices is further examined under varying geometric and freestream parameters. The optimal spanwise wavelength is insensitive to the total turning angle beyond a critical value, but sensitive to the concave curvature $ K$ at the same turning angle. A limit spanwise wavelength $ 1.96\delta$, corresponding to an infinite concave curvature as $ K\rightarrow \infty$, is identified and validated. Increasing the freestream Mach number or decreasing the ratio of wall temperature to freestream temperature reduces the optimal wavelength normalised by $ \delta$, while variations in freestream Reynolds number have negligible impact. Additionally, a modified definition of the turbulent Görtler number $ G_{T}$ based on the peak eddy viscosity in boundary layers is proposed and employed to assess the occurrence of Görtler instability.
The varieties of capitalism thesis suggest high-income democracies cluster into distinct types, with complementarities between political, economic, and social institutions shaping long-run cross-national differences. Although featuring strongly in the comparative political economy and social policy literatures, criminal justice has received relatively little attention in this debate, but some have suggested penal policy variations map against varieties of capitalism ideal types. Using fuzzy-set qualitative comparative analysis – and data for 22 Organisation for Economic Co-operation and Development (OECD) countries over a 25-year period – we explore connections between cross-national differences in penal punitiveness and key institutional features identified in these debates. We find that the degree of punitiveness strongly overlaps with varieties of capitalism ideal types, arguing criminal justice regimes constitute a dimension of institutional complementarity in varieties of capitalism.
Using the dual-pathway framework (Beach et al., 2022a), we tested a Neuro-immune Network (NIN) hypothesis: i.e., that chronically elevated inflammatory processes may have delayed (i.e., incubation) effects on young adult substance use, leading to negative health outcomes. In a sample of 449 participants in the Family and Community Health Study who were followed from age 10 to age 29, we examined a non-self-report index of young adult elevated alcohol consumption (EAC). By controlling self-reported substance use at the transition to adulthood, we were able to isolate a significant delayed (incubation) effect from childhood exposure to danger to EAC (β = −.157, p = .006), which contributed to significantly worse aging outomes. Indirect effects from danger to aging outcomes via EAC were: GrimAge (IE = .010, [.002, .024]), Cardiac Risk (IE = −.004, [−.011, −.001]), DunedinPACE (IE = .002, [.000, .008]). In exploratory analyses we examined potential sex differences in effects, showing slightly stronger incubation effects for men and slightly stronger effects of EAC on aging outcomes for women. Results support the NIN hypothesis that incubation of immune pathway effects contributes to elevated alcohol consumption in young adulthood, resulting in accelerated aging and elevated cardiac risk outcomes via health behavior.
Contemporary anti- trans political discourse has rendered knowledge of trans history inextricable from trans allyship. Leveraging the idea of trans people's newness – sometimes as a trend which can be trivially dismissed, sometimes as an emergent threat against which new laws must be forged to protect the gender- conforming majority – anti- trans campaigners have politicised the very idea of trans historicity (Heyam, 2022). While it is certainly true that a combination of increased trans visibility and (increasingly fragile) advances in legal equality has resulted in increased numbers coming out as trans and seeking medical transition, the long, global history of non- conforming and de- essentialised conceptualisations of gender is also increasingly well documented (Feinberg, 1994; Stryker, 2017; Raskolnikov et al, 2021; Heyam, 2022). As a result, the ethical and political importance of knowing and talking about the existence of trans history is also increasingly well understood among trans- supportive individuals.
Yet for practitioners working with older trans adults, knowledge of trans history is not simply valuable as part of a generalised ethical commitment to equality and allyship. At a deeper, more systemic level, I want to argue here that knowledge of trans history is an undervalued form of cultural competence in supporting older trans people. As such, it deserves to be understood as an integral part of professional development for practitioners in this area: neither situated as primarily a tactic for combatting anti- trans political arguments, nor confined to focal points such as LGBT+ History Month, but acknowledged as a central element of professional practice.
In framing knowledge of trans history as ‘cultural competence’, I want to align it with other kinds of knowledge necessary for effective, empathetic care: to emphasise that it is of equal value to knowledge of service users’ cultural or religious values and practices and their often culturally specific understandings of themselves and their place in their communities. A lack of cultural competence can lead practitioners to make inaccurate assumptions about those they support, leading to the provision of care that fails to meet their needs. By contrast, developing cultural competence can facilitate person- centred support and build effective relationships between practitioners and those they care for.
Existing systematic reviews related to advance care planning (ACP) largely focus on specific groups and intervention efficacy or are limited to contextual factors. This research aims to identify the modifiable factors perceived by different users of ACP in healthcare settings and inform healthcare professionals about the factors affecting ACP practice.
Methods
Five English-language databases (ProQuest, PubMed, CINAHL Plus, Scopus, and Medline) and two Chinese-language databases (CNKI and NCL) were searched up to November 2022. Empirical research identifying factors related to ACP in healthcare settings was included. ACP is defined as a discussion process on future end-of-life care. Thematic synthesis was performed on all included studies.
Results
A total of 1871 unique articles were screened; the full texts of 193 were assessed by 4 reviewers, and 45 articles were included for analysis. Twenty-two (54%) studies were qualitative, 15 (33%) were quantitative, and 6 (13%) used mixed methods. Foci varied from 28 (62%) studies on a single subject group (either patient, family, or physician), 11 (25%) on 2 subject groups (either patient and family or patient and healthcare professional), and 6 (13%) covered 3 subject groups (patient, family, and healthcare professional). Among the 17 studies involving more than 1 subject group, only 2 adopted a dyadic lens in analysis. Complex interwoven factors were categorized into (1) intrapersonal factors, (2) interpersonal factors, and (3) socio-environmental factors, with a total of 11 themes: personal belief, emotions, the burden on others, timing, responsiveness, relationship, family dynamics, experience, person taking the lead, culture, and support.
Significance of results
Patients, families, and healthcare professionals are the essential stakeholders of ACP in healthcare settings. Factors are interweaved among the intrapersonal, interpersonal, and socio-environmental dimensions. Research is warranted to examine the dynamic interactions of the 3 essential stakeholders from a multidimensional perspective, and the mechanism of the interweaving of factors.
The objective of this study was to explore barriers and enablers to improving the management of bacteriuria in hospitalized adults.
Design:
Qualitative study.
Setting:
Nova Scotia, Canada.
Participants:
Nurses, physicians, and pharmacists involved in the assessment, diagnosis, and treatment of bacteriuria in hospitalized patients.
Methods:
Focus groups (FGs) were completed between May and July 2019. FG discussions were facilitated using an interview guide that consisted of open-ended questions coded to the theoretical domains framework (TDF) v2. Discussions were transcribed verbatim then independently coded to the TDFv2 by two members of the research team and compared. Thematic analysis was used to identify themes.
Results:
Thirty-three healthcare providers from five hospitals participated (15 pharmacists, 11 nurses, and 7 physicians). The use of antibiotics for the treatment of asymptomatic bacteriuria (ASB) was the main issue identified. Subthemes that related to management of ASB included: “diagnostic uncertainty,” difficulty “ignoring positive urine cultures,” “organizational challenges,” and “how people learn.” Barriers and/or enablers to improving the management of bacteriuria were mapped to 12 theoretical domains within these subthemes. Barriers and enablers identified by participants that were most extensively discussed related to the domains of environmental context and resources, belief about capabilities, social/professional role and identity, and social influences.
Conclusions:
Healthcare providers highlighted barriers and recognized enablers that may improve delivery of care to patients with bacteriuria. A wide range of barriers at the individual and organization level to address diagnostic challenges and improve workload should be considered to improve management of bacteriuria.
Previous literature suggests that the gig economy and platform work pose challenges to social policy, including the welfare entitlement issues caused by workers’ ambiguous occupational status. Focusing on the government’s regulatory role, this study investigates platform workers’ occupational welfare (OW) by conducting in-depth interviews with forty-six food delivery workers in Hong Kong. The evidence reveals workers’ occupational risks resulting from platforms’ algorithmic devices and the misclassification of independent contractors. The denied access to private occupational pensions was considered acceptable by workers because of the perceived irrelevance of OW. While interviewees emphasised time-based flexibility as a key intangible benefit, the shifting business costs to self-employed workers was highlighted as a disadvantage. A policy dilemma appears between strengthening state regulation/protection and maintaining workers’ temporal autonomy. Arguably, the platformisation of work is translated into the gigification of OW, disentitling platform workers’ employer-provided welfare and labour protection. Platforms possess monopolising power over workers, the state displays weak regulatory power to monitor platforms, and workers’ occupational citizenship is undermined by the government’s minimal intervention. This study contributes to the literature by linking OW to platform work and revealing how the gig economy reshapes social policy, empirically offering a worker-centred analysis of OW in Hong Kong.
Leading international scholars present analysis and case studies from different cultural settings, East and West, exploring aesthetic interest and experience in our daily lives at home, in workplaces, using everyday things, in our built and natural environments, and in our relationships and communities. A wide range of views and examples of everyday aesthetics are presented from western philosophical paradigms, from Confucian and Daoist aesthetics, and from the Japanese tradition. All indicate universal features of human aesthetic lives together with their cultural variations. Comparative Everyday Aesthetics is a significant contribution to a key trend in international aesthetics for thinking beyond narrow art-centered conceptions of the aesthetic. It generates global discussions about good, aesthetic, everyday living in all its various aspects. It also promotes aesthetic education for personal, social, and environmental development and presents opportunities for global collaborative projects in philosophical aesthetics.
This study aims to examine (1) the prevalence of demoralization among family caregivers of palliative care patients (PCP) in Hong Kong, (2) the percentage of caregivers who are demoralized but not depressed, (3) the factors associated with demoralization, and (4) the differences in caregivers’ support needs between high and low levels of demoralization groups.
Methods
Ninety-four family caregivers were recruited and completed a questionnaire that included measures of demoralization, depression and caregiving strain, caregivers’ support needs, and demographic information.
Results
The prevalence of demoralization among family caregivers of PCP was found to be 12.8% (cutoff score = 50) and 51.1% (cutoff score = 30). Although 27.7% of caregivers met the criteria of depression and demoralization, 12.8% of demoralized caregivers were not depressed. Depression and caregiving strain were identified as the predictors of demoralization. Caregivers with a poorer subjective physical status and a lower education level are more prone to demoralization. The three major caregivers’ needs for support reported were (1) knowing what to expect in the future (77.7%); (2) knowing who to contact (74.5%); and (3) understanding your relative’s illness (73.4%). Those who experienced a high level of demoralization often reported more need for support in end-of-life caregiving.
Significance of results
This is the first study that focused on the demoralization of family caregivers of PCP in the East Asian context. Demoralization is prevalent among these caregivers. We recommend that early assessment of demoralization among family caregivers of PCP be considered, especially for those who are more depressed and have a higher level of caregiving stress.
Young people experience different treatment compared to older adults in the English welfare and homelessness systems, encountering varying levels of protection and disadvantage. This paper uses a value-pluralist perspective to explore the normative rationales for and the ethical defensibility of these policy differences. Evidence from 38 key informant interviews suggests that the English homelessness system is shifting towards a vulnerability-oriented response to young people. But an inconsistent value framework within the welfare system systematically disadvantages them without offering a corresponding degree of protection. As such, these closely-connected areas of social policy pull in opposing directions. Although individual positions targeting young people may (to greater and lesser extents) be justifiable, this disparity in values creates an incoherent and indefensible welfare policy landscape for this group.
Negative symptoms are an important symptom dimension in schizophrenia that are often least responsive to antipsychotic medications. We revisit the current practice of identifying ‘primary’ negative symptoms and suggest that its concept would benefit from a further elaboration of their timing of emergence in relation to the dynamic neurobiological changes to enhance their utility in clinical decision-making and research.
Background: According to the World Health Organization (WHO), as of April 9, 2022, there had been 494,587,638 confirmed COVID-19 cases and 6,170,283 deaths reported worldwide. In Hong Kong, in recent outbreak, ~55% of confirmed cases were residential care home (RCH) residents and >800 staff were infected. In 2016, ~15% of people aged ≥80 years were living in residential care homes. Objectives: To assess healthcare worker (HCW) knowledge level and attitudes about PPE use in residential care homes. Methods: This cross-sectional study, included participants who worked in the residential care homes, registered as healthcare workers (HCWs). HCWs who were part-time staff or worked <3 months in the residential care home were excluded. Ethical review approval from the faculty research committee of the university was obtained in January 2022. The Knowledge, Attitude, Practical (KAP) questionnaire was adapted. The questionnaire has 33 items pertaining to knowledge, attitude, and practice regarding PPE. Results: In total, 50 questionnaires were received; 32 respondents (64%) were female and 18 (36%) were male. Nearly half of the participants had completed a high diploma course, and 32% had graduated from secondary school. Using ANOVA, there were no significant differences of education level of participants or participant knowledge level of PPE [F(2,47) = .181; P = .835], attitudes [F(2,47) = 1.995; P = .147] and practice [F(2,47) = .459; P = .635]. The Pearson correlation was used to measure the relationship between knowledge level and PPE practices. Our results indicated a significant difference and moderate correlation between knowledge level and PPE practice among HCWs. Conclusions: Knowledge level does not directly affect HCW practice regarding PPE. PPE practice skills have been influenced by various factors during the pandemic situation, such as availability of PPE, manpower, workload, and communication.