BackgroundImplementation of recommendations from clinical practice guidelines is essential for evidence based clinical practice. However, the most effective methods of implementation are unclear. We conducted a national, cluster-randomised, blinded implementation trial to determine if midwife or doctor local implementation leaders are more effective in implementing a guideline for use of oral dextrose gel to treat hypoglycaemic babies on postnatal wards. To prevent any conscious or unconscious performance bias both the doctor and midwife local implementation leaders were kept unaware of the (...) trial. This paper reports the ethical dilemmas and practical challenges of ensuring clinicians remained unaware of their involvement in an implementation trial.MethodsWe sought approval from the National Health and Disability Ethics committee to keep clinicians unaware of the trial by waiving the standard requirement for locality approval usually required for each district health board. The ethics committee did not approve a waiver of consent but advised that we approach the chief executive of each district health board to ask for provisional locality approval. Ultimately it was necessary to seek ethics approval for three separate study designs to keep clinicians unaware of the trial.ResultsThe median time for chief executive approval was 16 days and for locality approval was 57 days. We completed 21 different locality approval forms for 27 hospitals.ConclusionsKeeping clinicians unaware of their involvement in a national implementation cluster-randomised trial is feasible. However, despite a national ethics committee, significant logistical challenges were time consuming and delayed trial completion. Co-ordination of the locality approval process would help facilitate multi-centre trials. (shrink)

Ben shu shi zuo zhe cong du shu bi ji zhong xie qu de yi zu san wen sui bi, fan ying le zuo zhe zai yi shu he zhe xue shang de tan suo yu zhui qiu.

Loneliness and solitude have similar attributes to individuals, but there is a critical variance between the two regarding the impact on the individual. Loneliness is an unpleasant feeling in a broad sense, while according to some philosophers, solitude is regarded as a joyful necessity when one establishes a deep relationship with the outside world. This article aims to develop a sensible account of the difference between solitude and loneliness by looking at some insightful philosophical viewpoints. Importantly, this article aims to (...) explain the dimensions in which solitude is a positive phenomenon. I will analyze the role of solitude in eliminating loneliness from two aspects: self-consciousness and self-knowledge construction. (shrink)

In previous decades, the well-being of teachers has been at the center of the attention of researchers in several practical investigations on various subjects such as language learning. The objective of this review is to clarify this construct and add new information on the predominance of the well-being of teachers and organize factors impacting it. Nevertheless, among factors influencing the levels of well-being, the focus of this review is on two constructs, namely, optimism “as a new concept in positive psychology,” (...) societal theory, and collective school assets in education, and efficacy of teachers as an individual source in teachers. This review tries to focus on the eminent role of teacher efficacy and optimism in the process of education and also clarify their consequences on the well-being of teachers. In a nutshell, this review can provide implications for language teaching participants in the academic context. (shrink)

Throughout Chinese history, the Legalists and the Confucians have always been antagonistic schools of thought. The idea that the Legalists have their origins in the Confucians, that they are the successors of the Confucians, is nonsense. Explaining the problem and clarifying the class nature of the Confucian-Legalist struggle has important and real significance for deepening the Campaign to Criticize Lin Piao and Confucius, for criticizing the reactionary thought of honoring Confucius and opposing Legalism, and for grasping class struggle in the (...) realm of ideology. (shrink)

As Part of the Omnibus Budget Reconciliation Act of 1990, the Patient Self Determination Act legislates new responsibilites for healthcare facilities. The authors served as members of the California Consortium on Patient Self-Determination, and the materials produced by this group offer healthcare facilities a valuable guide for implementing the PSDA. The ACt follows a historical trend led by doctrines of informed consent and increasing patient autonomy regarding rights to accept or refuse medical treatment and to execute advance directives. The requirements (...) of the Act will influence healthcare facilities and how they communicate with patients about advance directives. Although the Act seeks to increase awareness of advance directices among all participants in healthcare interactions, it could pose major stumbling blocks to providing sensitive and humane care if certain concerns are nor addressed adequatley. The benefits of the Act could be far reaching and substantial for patients and healthcare facilities alike. (shrink)

Olwen Bedford and Kwang-Kuo Hwang, Guilt and Shame in Chinese Culture: A Cross-cultural Framework from the Perspective of Morality and Identity, pp. 127–144.This article formulates a cross-cultural framework for understanding guilt and shame based on a conceptualization of identity and morality in Western and Confucian cultures. First, identity is examined in each culture, and then the relation between identity and morality illuminated. The role of guilt and shame in upholding the boundaries of identity and enforcing the constraints of morality is (...) then discussed from the perspective of each culture. The developed framework is then applied the emotions of guilt and shame in Chinese culture drawing on previous field research. Implications for future research are discussed. (shrink)

In addition to monocentric eukaryotes, which have a single localized centromere on each chromosome, there are holocentric species, with extended repeat‐based or repeat‐less centromeres distributed over the entire chromosome length. At least two types of repeat‐based holocentromeres exist, one composed of many small repeat‐based centromere units (small unit‐type), and another one characterized by a few large centromere units (large unit‐type). We hypothesize that the transposable element‐mediated dispersal of hundreds of short satellite arrays formed the small centromere unit‐type holocentromere in Rhynchospora (...) pubera. The large centromere unit‐type of the plant Chionographis japonica is likely a product of simultaneous DNA double‐strand breaks (DSBs), which initiated the de novo formation of repeat‐based holocentromeres via insertion of satellite DNA, derived from extra‐chromosomal circular DNAs (eccDNAs). The number of initial DSBs along the chromosomes must be higher than the number of centromere units since only a portion of the breaks will have incorporated eccDNA at an appropriate position to serve as future centromere unit sites. Subsequently, preferential incorporation of the centromeric histone H3 variant at these positions is assumed. The identification of repeat‐based holocentromeres across lineages will unveil the centromere plasticity and elucidate the mechanisms underlying the diverse formation of holocentromeres. (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)

Beyond protein synthesis and autophagy, emerging evidence has implicated mTORC1 in regulating protein folding and proteasomal degradation as well, highlighting its prominent role in cellular proteome homeostasis or proteostasis. In addition to growth signals, mTORC1 senses and responds to a wide array of stresses, including energetic/metabolic stress, genotoxic stress, oxidative stress, osmotic stress, ER stress, proteotoxic stress, and psychological stress. Whereas growth signals unanimously stimulate mTORC1, stresses exert complex impacts on mTORC1, most of which are repressive. mTORC1 suppression, as a (...) generic adaptive strategy, empowers cell survival under various stressful conditions. In this essay, we provide an overview of the emerging role of mTORC1 in proteostasis, the distinct molecular mechanisms through which mTORC1 reacts to diverse stresses, and the schemes exploited by cancer cells to circumvent stress‐induced mTORC1 suppression. Hence, acting as a stress sensor, mTORC1 intimately couples stresses to cellular proteostasis. (shrink)

Jeremy sustained bilateral complete brachial plexus injuries in an auto collision on an icy road a month before his third birthday. The accident rendered both upper extremities completely flail and insensate: he has no motor or sensory function of his shoulders, elbows, wrists, or digits. Jeremy does, however, have normal function of the lower extremities. Physical therapists have worked with the child for over a year with no noted improvement in arm function. Jeremy falls frequently, causing injury to his face (...) and head, and occasionally, his arms get twisted or caught in his crib and his fingers turn blue. Jeremy's mother, who carries the main responsibility for his daily care, believes that his insensate arms are too heavy and “get in his way,” causing the falls. She and Jeremy's father present to the orthopedic clinic at the children's hospital with the request of having both arms amputated. The primary orthopedic surgeon and the orthopedic team disagree with the parents that bilateral upper-extremity amputation offers any medical benefit, but Jeremy's mother tells the surgeon that, if he will not perform the surgery, her family will find a doctor who will. The surgeon, who feels ethically distressed by the parental insistence on this amputation in such a young child, requests an ethics consultation. (shrink)

Genetic cancer predisposition testing in the paediatric population poses unique ethical dilemmas. Using the hypothetical example of a teenager with cancer with a high probability of having an underlying cancer predisposition syndrome, we discuss the ethical considerations that affect the decision-making process. Because legally these decisions are made by parents, genetic testing in paediatrics can remove a child’s autonomy to preserve his or her own ‘open future’. However, knowledge of results confirming a predisposition syndrome can potentially be beneficial in modifying (...) treatment and surveillance plans and enabling at-risk family members to obtain cascade testing for themselves. Considering virtue ethics to envision the best characters of the patient, parents and healthcare providers can guide them to the better choice to test or not to test, with the ultimate goal of achieving the best outcome for survival andeudaimonia, human flourishing reliably sought out. (shrink)

Social media has been widely applied by major religions throughout the world to enhance cohesion among believers. Although a considerable amount of research has focused on the effect of social media on the beliefs of Christianity and Islam, East Asian religions have seldom been featured in current research. This study, therefore, took a representative sample of individuals participating in the celebration of the festival of the goddess Mazu and measured their attitudes towards and perceptions of social media’s influence on folk (...) religion. I also explored how social media stimulates transformation in Chinese folk religion, its influence on the preservation of cultural values, and the cross-industry alliance between folk temples and local businesses. Moreover, this study proposes suggestions for further research. (shrink)

Do experiences with nature –– from wilderness backpacking to plants in a preschool to a wetland lesson on frogs, promote learning? Until recently, claims outstripped evidence on this question. But the field has matured, not only substantiating previously unwarranted claims but deepening our understanding of the cause-and-effect relationship between nature and learning. Hundreds of studies now bear on this question, and converging evidence strongly suggests that experiences of nature boost academic learning, personal development, and environmental stewardship. This brief integrative review (...) summarizes recent advances and the current state of our understanding. The research on personal development and environmental stewardship is compelling although not quantitative. Report after report –– from independent observers as well as participants themselves –– indicate shifts in perseverance, problem-solving, critical thinking, leadership, teamwork, and resilience. Similarly, over fifty studies point to nature playing a key role in the development of pro-environmental behavior, particularly by fostering an emotional connection to nature. In academic contexts, nature-based instruction outperforms traditional instruction. The evidence here is particularly strong, including experimental evidence; evidence across a wide range of samples and instructional approaches; outcomes such as standardized test scores and graduation rates; and evidence for specific explanatory mechanisms and active ingredients. Nature may promote learning by improving learners’ attention, levels of stress, self-discipline, interest, and enjoyment in learning, and physical activity and fitness. Nature also appears to provide a calmer, quieter, safer context for learning; a warmer, more cooperative context for learning; and a combination of “loose parts” and autonomy that fosters developmentally beneficial forms of play. It is time to take nature seriously as a resource for learning — particularly for students not effectively reached by traditional instruction. (shrink)

This commentary reflects on recent instances of anti-Asian violence and state responses to redress violence through data-driven strategies. Data collection often presents itself as an appealing strategy, due to impacted communities’ desires for evidence and metrics to substantiate political claims. Yet, data collection can bolster the carceral state. This commentary takes an antagonistic approach to policing, including the ongoing creation of data infrastructures by—and for—law enforcement through hate crimes legislation. We critically discuss the challenges and possibilities in building towards anti-carceral (...) responses amidst ongoing racial violence and crisis. (shrink)

Ben shu shi zuo zhe cong du shu bi ji zhong xie qu de yi zu san wen sui bi, fan ying le zuo zhe zai yi shu he zhe xue shang de tan suo yu zhui qiu.

“It's more important to look honest than it is to get anything done.” Municipal Agency Commissioner in New York City; Interview, 1991.

Evidence supports predictive roles of non-social smartphone use for smartphone addiction, but the relationship of social smartphone use and smartphone addiction is unclear. This study explored whether social smartphone use has a double-edged impact on smartphone addiction. Using data from a sample of 909 Chinese undergraduates, we tested a parallel mediation model that considered online social support and realistic social support as mediators. As predicted, social smartphone use weakened smartphone addiction through realistic social support and contributed to smartphone addiction through (...) online social support. Moreover, we tested the moderating role of agreeableness in the mediation path of online social support. Agreeableness only moderated the indirect effects. Specifically, the predictive effects of online social support on smartphone addiction was greater for lower rather than higher agreeableness. The results suggest that social needs play an important role in the formation of smartphone addiction. Several limitations and implications are also discussed herein. (shrink)