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This study aimed to update the incidence of device-associated healthcare-associated infections (DA-HAIs), and to characterize pathogen distribution and carbapenem-resistant Enterobacteriaceae (CRE) detection among ICU patients in Shanghai, China.
Methods:
Prospective surveillance in 223 ICUs using standardized International Nosocomial Infection Control Consortium methodology (INICC) protocols collected patient-level data on demographics, microbiology, device use, and DA-HAIs. Trends, annual percent change (APC) and average annual percent change (AAPC) were estimated using Joinpoint regression models.
Results:
The overall DA-HAIs incidence density in ICUs was 1.67 per 1000 catheter-days for catheter-associated urinary tract infection (CAUTI) (95% CI: 1.62–1.73), 0.59 per 1000 central line-days for central line-associated bloodstream infection (CLABSI) (95% CI: 0.56–0.63), and 4.63 per 1000 ventilator-days for ventilator-associated pneumonia (VAP) (95% CI: 4.51–4.76). Significant reductions were observed in VAP (AAPC: −15.36%; P < 0.001) and CLABSI (AAPC: −11.23%; P < 0.001). Pathogen distributions varied by infection type, with Enterococcus faecium (17.22%) and Klebsiella pneumoniae (16.63%) predominating in CAUTI patients, Klebsiella pneumoniae (26.87%) in CLABSI patients, and Acinetobacter baumannii (37.60%) in VAP patients. The overall CRE detection rate was 33.67% in CAUTI patients, 37.56% in CLABSI patients, and 35.24% in VAP patients.
Conclusions:
Although DA-HAI rates showed significant declines, the persistently high CRE prevalence underscores substantial antimicrobial resistance challenges in Chinese ICUs.
Antimicrobial resistance (AMR) is a global health challenge, highlighting the need for antibiotic stewardship policies. We evaluated the impact of the National Action Plan to Contain Antimicrobial Resistance (2022–2025) on antibiotic use among primary healthcare institutions (PHIs) in Central China.
Design:
A segmented interrupted time-series analysis from January 2021 to December 2023.
Methods:
We collected data from 1510 PHIs, by region, types of healthcare institutions and medication type, assessing antibiotic consumption using defined daily doses per 1000 inhabitants per day and the quality by the percentage of broad-spectrum antibiotics.
Results:
Post-intervention, antibiotic consumption declined by −35.96% (95%CI: –49.34 to –22.57), and the proportion of broad-spectrum antibiotic use decreased by –41.97% (–61.74 to –22.20). Consumption dropped significantly in both moderately developed areas and underdeveloped areas, while highly developed areas saw the largest reduction in broad-spectrum antibiotic use. Rural PHIs also showed notable declines in both overall antibiotic consumption and broad-spectrum usage.
Conclusions:
The policy was associated with a reduction in antibiotic use across PHIs, though regional disparities in its implementation suggest uneven benefits.
To investigate the effects of activating/inhibiting AmelSmo on the olfactory genes and signalling pathways of Apis mellifera ligustica, as well as the potential regulatory mechanisms involved. Transcriptomic sequencing was performed on Apis mellifera ligustica antennae using Illumina HiSeq platform following administration of cyclopamine (inhibitor) and purmorphamine (agonist). Differential gene expression analysis, coupled with GO and KEGG pathway annotations, facilitated the identification of olfactory receptor genes. The reliability of transcriptome data was subsequently validated through quantitative real–time–polymerase chain reaction analysis. Transcriptomic analysis revealed 12,356 differentially expressed genes (DEGs) between inhibitor and control groups, with 276 genes showing significant differential expression. Similarly, 12,356 DEGs were identified between the agonist and control groups, among which 672 genes exhibited significant differential expression. The GO annotation revealed that the DEGs in the inhibitor group and the agonist group were mainly enriched in the biological process such as cellular process, metabolic process, and biological regulation; in cellular component, enrichment was mainly observed in cell, cell part, and organelle; and in molecular function, the main enrichment was in binding and catalytic activity. KEGG pathway analysis indicated that DEGs from both groups were primarily enriched in signal transduction pathways. Among the DEGs, three olfactory receptor genes were identified in the inhibitor group: odorant receptor 19, odorant receptor 22, and odorant receptor 5. The agonist group exhibited two olfactory receptor genes: odorant receptor 109 and odorant receptor 26. All these olfactory receptor genes demonstrated downregulated expression patterns. Transcriptomic sequencing analysis identified five olfactory receptor genes. The changes in gene expression levels suggest that the activation or inhibition of AmelSmo may regulate the expression of olfactory receptors via the Hedgehog signalling pathway. It is speculated that AmelSmo may play a regulatory role in the olfactory system of bees.
Temperature is the most significant abiotic factor that affects the growth and behaviour of insects. However, the mechanism by which the olfactory system senses thermal stimulus and combines temperature and chemical signals to trigger certain behavioural outputs is unclear. This study aimed to clarify the mechanism by which environmental temperature affects olfactory perception in Apis cerana cerana (Hymenoptera: Apidae). We used quantitative reverse-transcriptase polymerase chain reaction and western blotting to analyse the expression of AcerOr1 and AcerOr2. We also used electroantennography (EAG) assays to detect bee antennal responses to odorants at different temperatures. The results revealed that the mRNA expression of AcerOr1 and AcerOr2 was significantly influenced by temperature. These genes exhibited both increases and decreases in expression over time, with the most significant differential observed at 25 °C. Protein expression was similarly affected at 2 hours after different temperature treatments. Electroantennography responses from the antennae revealed that six odorant volatiles – N-(4-ethylphenyl)-2-((4-ethyl-5-(3-pyridinyl)-4H-1,2,4-triazol-3-yl)thio)acetamide (VUAA1), linolenic acid, eugenol, hexyl acetate, 1-nonanol, and lauroleic acid – had the most dramatic effect at 25 °C. The results indicate that environmental factors affecting the expression of AcerOr1 and AcerOr2 modulate olfactory recognition behaviour in A. cerana cerana, suggesting that changes in environmental temperature can affect bees’ olfactory preferences.
Moderate and deep sedation occurs in numerous settings, and healthcare providers may unexpectedly find themselves in situations where emergency resuscitation of patients will be required. A discussion of key concepts found in the latest American Heart Association (AHA) guidelines follows, to prepare the provider for these potential emergencies. For more detailed information, the reader is referred to the 2020 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care [1].
The delivery of sedation to children presents a significant challenge to many clinicians from a variety of specialties on a daily basis [1]. While tremendous evidence exists to guide the clinician through the pharmacology, physiology, and medical issues involved, the final sedative regimen is most likely based on the specific training of the provider and the experience that the individual brings to the procedure [1]. Collectively, all providers tasked with providing sedation to children must acknowledge the inherent limitations of their experiences and training; only then can clinicians bring sober and intelligent judgment to this critical arena.
Healthcare practitioners must always be prepared for an emergency situation in which they are responsible for the initial resuscitation of their patient. While the principles behind the emergency resuscitation of adults can be broadly applied to pediatric patients, there are many important differences to be noted. In infants and children, cardiac arrest most commonly occurs as the end result of progressive respiratory failure – hypoxemia, hypercapnia, and acidosis leading to bradycardia and hypotension, and, ultimately, cardiac arrest. This is in contrast to adults, in whom cardiac arrest is most often due to a primary cardiac cause. Pulseless ventricular tachycardia (VT) and ventricular fibrillation (VF) are found as the initial cardiac rhythm in approximately 7–10% of pediatric patients, with their incidence increasing with age. This chapter outlines an approach toward the resuscitation of pediatric patients adapted from the 2020 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation and emergency cardiovascular care [1].
The study explored the origin of the age of acquisition (AoA) effect in second language (L2) using ERPs technique. We simulated L2 AoA by manipulating the order at which English pseudowords entered into training. Chinese-English bilinguals (mean age 22.04, range 18–28) learned English pseudowords matched with Chinese (L1) words, investigating the order of acquisition (OoA) effect of English pseudowords and its relationship with the matched L1 words’ AoA. OoA effects were observed in lexical decision, naming and semantic judgment tasks on N170, P200 and N400. Furthermore, OoA effects were modulated by L1 AoA in the semantic judgment task. These results suggested that OoA effects were independent at orthographic and phonological levels but modulated by L1 AoA at the semantic level. The interpretation of L2 AoA effects requires not only the integration of Semantic and Arbitrary Mapping Hypotheses, as well as consideration of the representation and activation characteristics of L2 words.
One of the challenges of population aging is the rising demand of elder care. Adult children fill a substantial portion of this care need. To understand its implication on their labor market choices and welfare outcomes, we build a simple static model where households can spend time and money producing care. We calibrate the model using data from the American Community Survey, the Health and Retirement Study, and National Health and Aging Trends Study/National Study of Caregiving to match moments in the labor market and caregiving patterns. With the calibrated model, we consider a few government programs under a projected aging population structure. Our results show that care subsidy and Medicaid expansion both cause a shift from informal care to formal care, relieving adult children from care burdens and thus improving their welfare. Caregiver allowance appears to have little effects on caregiving behaviors, which leads to minimal welfare improvement.
The myriad applications of artificial intelligence (AI) by the private and public sectors have exploded in the public consciousness in the postpandemic period. However, researchers and businesses have been working on AI technology applications for decades, and in many ways, governments are rushing to catch up. This article presents an argument that the future of AI policy in the United States will be driven in large part by current and future state-level policy experiments. This argument is presented by drawing on scholarship surrounding federalism, regulatory fragmentation, and the effects of fragmentation on business and social equity. The article then presents the case of autonomous vehicle policy in the states to illustrate the degree of current fragmentation and considers the effects of layering new AI policies on top of existing rules surrounding privacy, licensing, and more. Following this consideration of existing research and its application of AI policy, the article presents a research agenda for leveraging state differences to study the effects of AI policy and develop a cohesive framework for governing AI.
To estimate the association of catastrophic health expenditure (CHE) with the risk of depression in middle-aged and old people in China.
Methods
We used data of 2011, 2013, 2015 and 2018 from the China Health and Retirement Longitudinal Study, which covered 150 counties of 28 provinces in China. CHE was calculated as out-of-pocket health expenditure exceeding 40% of a household’s capacity to pay. Depression was measured by a 10-item Centre for Epidemiological Studies Depression Scale. We evaluated CHE prevalence and applied Cox proportional hazard models to estimate adjusted hazard ratios (aHRs) and 95% confident intervals (CIs) for the risk of depression among participants with CHE after controlling potential confounders, compared with those without CHE.
Results
Among 5765 households included in this study, CHE prevalence at baseline was 19.24%. The depression incidence of participants with CHE (8.00 per 1000 person-month) was higher than that of those without CHE (6.81 per 1000 person-month). After controlling confounders, participants with CHE had a 13% higher risk (aHR = 1.13, 95% CI: 1.02–1.26) of depression than those without CHE. In subgroup analysis, the association of CHE with depression was significant in males and in people with chronic diseases, of younger age, living in rural areas and of lowest family economic level (all P < 0.05).
Conclusions
Nearly one of five middle-aged and old people in China incurred CHE, and CHE was associated with the risk of depression. Concerted efforts should be made to monitor CHE and related depression episode. Moreover, timely interventions about CHE and depression need to be implemented and strengthened among middle-aged and old people.
This study presents a conceptual replication of Birulés et al.’s (2020, Experiment 2) investigation of native and nonnative listeners’ selective attention to a talker’s mouth with the goal of better understanding the potentially modulating role of proficiency in listeners’ reliance on audiovisual speech cues. Listeners’ eye gaze was recorded while watching two short videos. Findings from one of the videos replicated results from the original study, showing greater attention to the talker’s mouth among L2 than L1 listeners. In both videos, L2 proficiency modulated attention, with more fixations on the mouth among lower proficiency listeners, an effect predicted but not observed in the original study. Collectively, these laboratory-based findings highlight the role of visual speech cues in L2 listening and present evidence that listeners with more limited proficiency may be especially reliant on such cues. These observations warrant future investigations of the benefits of visual speech cues in instructional and assessment contexts.
Given the rising burden of palliative care and the limited human resources for its facilitation in China, volunteers are becoming increasingly indispensable. In particular, there is a high demand for volunteers who can serve as spiritual caregivers. However, a volunteer’s ability to provide good spiritual care in a palliative setting may be influenced by their attitude toward palliative care. To uncover the current state of spiritual caregiving in palliative settings in China and insights into best practices for its improvement, this study measured spiritual care competence and identified its influencing factors and explored its relationship with attitudes toward palliative care among volunteers. Notably, this study is the first to consider spiritual care competence alongside attitudes toward palliative care.
Methods
A descriptive cross-sectional study using online survey methods was conducted with 385 volunteers in Shanghai, China. Data were collected using a structured questionnaire.
Results
Volunteers demonstrated relatively low levels of spiritual care competence (58.50 ± 10.92). Statistically significant correlations were found between spiritual care competence and the following variables: age, educational background, marital status, religious beliefs, occupational status, and relevant training and practical experience. Attitude toward palliative care significantly correlated with spiritual care competence (r = 0.49, p < 0.001).
Significance of results
To continually improve volunteers’ spiritual care competence, diversified education and training programs about spiritual care should be designed for different kinds of volunteers; moreover, because attitude toward palliative care significantly impacted spiritual care competence, such programs should encourage positive attitudes toward palliative care.
The present study investigated the age of acquisition (AoA) effect in processing second language (L2) words and how it is related to the AoA of the corresponding first language (L1) words. We adopted a lexical decision task in three experiments. The filler words were orthographically illegal in Experiment 1 to elicit more word form processing, while Experiment 2 used legal fillers to shift the bias toward semantic processing. In Experiment 3, we used a larger amount of stimuli containing more longer words with legal fillers. Our results showed that L2 AoA has a weak effect at the orthographical processing level and a stable effect at the semantic processing level. The L1 AoA modulates the L2 AoA effect at the semantic processing level, which is more likely to appear in long words. These results suggest that it is important to take bilingual representation and activation into consideration to explain the L2 AoA effect.
The science of team science (SciTS) is an emerging research area that studies the processes and outcomes of team-based research. A well-established conceptual framework and appropriate methodology for examining the effectiveness of team science are critically important for promoting and advancing collaborative and interdisciplinary research. Although many instruments have been developed and used in the SciTS field, psychometric evidence has not been routinely assessed or reported for these scales. In addition, commonly used psychometric methods were mainly limited to internal consistency and factor analysis. To fill the gaps, this study introduces a framework based on Rasch measurement theory for creating and evaluating measures for team sciences.
Methods:
We illustrate the application of Rasch measurement theory through the creation of valid measures to evaluate the processes of interdisciplinary scientific teams. Data were collected from 16 interdisciplinary teams through a university-wide initiative for promoting interdisciplinary team collaboration. Psychometric evidence based on a many-facet Rasch model was obtained for assessing the quality of the measures.
Results:
The interdisciplinary teams differed in their clarity measures. Significant differences were also found between gender groups, racial groups, and academic ranks. We reported the reliability of measures and identified items that do not fit the model and may present potential threat to validity and fairness of SciTS measures.
Conclusion:
This study shows the great potential of using Rasch measurement theory for developing and evaluating SciTS measures. Applying Rasch measurement theory produces objective measures that are comparable across individuals, interdisciplinary teams, institutions, time, and various demographic groups.
This study aimed to describe diet quality of pregnant women and explore the association between maternal diet and the prevalence of low birth weight (LBW) and small for gestational age (SGA). A total of 3856 participants from a birth cohort in Beijing, China, were recruited between June 2018 and February 2019. Maternal diet in the first and second trimesters was assessed by the Chinese diet balance index for pregnancy (DBI-P), using data collected by the inconsecutive 2-d 24-h dietary recalls. Logistic regressions were performed to explore the independent effects of DBI-P components on LBW and SGA. The prevalence of LBW and SGA was 3·8% and 6·0%, respectively. Dietary intakes of the participants were imbalanced. The proportions of participants having insufficient intake of vegetables (87·3% and 86·6%), dairy product (95·9% and 96·7%) and aquatic foods (80·5% and 85·3%) were high in both trimesters. The insufficiency of fruit intake was more severe in the second (85·2%) than that in the first trimester (22·5%) (P < 0·05). After adjusting for potential confounders, the intake of fruits and dairy in the second trimester was negatively associated with the risk of LBW (OR = 0·850, 95% CI: 0·723, 0·999) and SGA (OR = 0·885, 95% CI: 0·787, 0.996), respectively. Sufficient consumption of fruits and dairy products in pregnancy may be suggested in order to prevent LBW and SGA.
Incentivizing the development of interdisciplinary scientific teams to address significant societal challenges usually takes the form of pilot funding. However, while pilot funding is likely necessary, it is not sufficient for successful collaborations. Interdisciplinary collaborations are enhanced when team members acquire competencies that support team success.
Methods:
We evaluated the impact of a multifaceted team development intervention that included an eight-session workshop spanning two half-days. The workshop employed multiple methods for team development, including lectures on empirically supported best practices, skills-based modules, role plays, hands-on planning sessions, and social interaction within and across teams. We evaluated the impact of the intervention by (1) asking participants to assess each of the workshop sessions and (2) by completing a pre/postquestionnaire that included variables such as readiness to collaborate, goal clarity, process clarity, role ambiguity, and behavioral trust.
Results:
The content of the team development intervention was very well received, particularly the workshop session focused on psychological safety. Comparison of survey scores before and after the team development intervention indicated that scores on readiness to collaborate and behavioral trust were significantly higher among participants who attended the workshop. Goal clarity, process clarity, and role ambiguity did not differ among those who attended versus those who did not.
Conclusions:
Multicomponent team development interventions that focus on key competencies required for interdisciplinary teams can support attitudes and cognitions that the literature on the science of team science indicate are predictive of success. We offer recommendations for the design of future interventions.
China's role in the international order has been changing in the past 50 years; the country has gone from being a non-power, to a regional power (Fitzgerald, 1955: 114, 118), to an emerging global power, to having the second largest economy in the world and ambitions to be considered as a great power. Since Deng Xiaoping's decision to reform and open up the Chinese economy, subsequent leaders have looked to establish China's place within the international order but also within the regional order. As Rebecca E. Karl (1998: 1118) reflects, ‘Asianism … has been a recurrent theme of the twentieth-century Chinese (and “Asian”) history’. The concept of Asia, according to Karl, has changed over time from cultural debates in the 1930s linking India and China's Eastern spirituality and pitting it against Western materialism, to Pan-Asianism (as in Sino-Japanese sameness) advocated by, for example, Wang Jingwei to justify his collaboration with the Japanese during their occupation of China in the 1940s and to Mao Zedong's Third Worldism rhetoric. For our argument, however, the most intriguing is China's support of the so-called ‘Confucian capitalist network’. According to Dirlik (1997), this phenomenon is best viewed as a manifestation of East Asia's global postcolonial discourse and the postcolonial revival of the native pasts, which simultaneously contests a Eurocentric global order (Dirlik, 1995: 230). Therefore, considering Pan-Asianism (or Asian regionalism with inherent Asian values) as a constant, stable, ahistorical unit of analysis is problematic. What is more, East Asia as a region is infused with the core values of Confucius philosophy (Shin, 2012: 3).
For China, the 2008 Beijing Olympics demonstrated a rediscovered national pride and China's return as a global actor. It also reiterated the role Confucianism played in this narrative (Cohen, 2007). During the opening ceremony of the Beijing Olympics, over 2,000 voices chanted the Confucian saying, ‘You Peng zi yuan fang lai, bu yi le hu?’ (有朋自 远方来, 不亦乐乎/To have friends come from afar is happiness, is it not?), to the beat of drums from the Xia (夏) Dynasty (China Daily, 2008). Although China's Confucian revival began gradually during the presidency of Hu Jintao, references to Confucius philosophy accelerated under the presidency of Xi Jinping (The Economist, 2015).
The synergetic effects of surface smoothing exhibited during the inductively coupled plasma reactive ion etching (ICP-RIE) of free-standing polycrystalline diamonds (PCDs) were investigated. Changing the assistive gas types generated variable surface oxidation states and chemical environments that resulted in different etching rates and surface morphologies. The main reaction bond mechanism (C–O) during ICP-RIE and the ratio of C–O–C/O–C=O associated with the existence of a uniform smooth surface with root mean square (RMS) roughness of 2.36 nm were observed. An optimal process for PCD smoothing at high etching rate (4.6 μm/min) was achieved as follows: 10% gas additions of CHF3 in O2 plasma at radio frequency power of 400 W. The further etched ultra-smooth surface with RMS roughness <0.5 nm at etching rate of 0.23 μm/min that being produced by transferring this optimum recipe on single crystal diamonds with surface patterns confirmed the effectiveness of the fast smoothing approach and its feasibility for diamond surface patterning.