To investigate the phenomenon of patient–physician mistrust in China, a qualitative study involving 107 physicians, nurses and health officials in Guangdong Province, southern China, was conducted through semi-structured interviews and focus groups. In this paper we report the key findings of the empirical study and argue for the essential role of medical professionalism in rebuilding patient-physician trust. Health professionals are trapped in a vicious circle of mistrust. Mistrust leads to increased levels of fear and self-protection by doctors which exacerbate difficulties (...) in communication; in turn, this increases physician workloads, adding to a strong sense of injustice and victimization. These factors produce poorer healthcare outcomes and increasingly discontented and angry patients, escalate conflicts and disputes, and result in negative media coverage, all these ultimately contributing to even greater levels of mistrust. The vicious circle indicates not only the crisis of patient-physician relationship but the crisis of medicine as a profession and institution. Underlying the circle is the inherent conflict of interest in the healthcare system by which health professionals and hospitals have become profit-driven. This institutional conflict of interest seriously compromises the fundamental principle of medical professionalism—the primacy of patient welfare—as well as the traditional Chinese ideal of “medicine as the art of humanity”. Patient trust can be restored through rectifying this institutional conflict of interest and promoting medical professionalism via a series of recommended practical measures. (shrink)

Despite the role of public health interventions in controlling disease transmission and protecting the public during the COVID-19 emergency, the implementation of quarantine restrictions has raised serious ethical concerns, especially in relation to the well-being of vulnerable populations. Drawing on the lived experiences of rural Chinese migrants who are subject to pandemic control, the authors highlight their inadequate capacities to manage the risks associated with the pandemic and adjust to quarantine restrictions. Informed by an ethical discourse of vulnerability, we show (...) that underpinning this group’s deficient coping strategies is a range of detrimental social structures and institutions that have developed under the persistent rural–urban divide in China. These structural constraints and pathologies expose rural migrants to serious risks and uncertainties while depriving them of the means and resources necessary to protect their own interests in the process of complying with quarantine restrictions. Understanding the plight of rural Chinese migrants as a structural problem also has implications for the global response to the COVID-19 pandemic. We further suggest a need for state intervention to mitigate structural deficiencies and empower the vulnerable during the COVID-19 era. (shrink)

This paper examines older people’s access to care experiences in rural China by integrating anthropological investigation with ethical inquiry. Six months of fieldwork in a post-reform primary hospital show how rural residents struggle to access gerontological and nursing care under socially disadvantageous conditions. This anthropological investigation highlights the unmet needs in medical and nursing care for older people, as well as some social, institutional and structural elements that impede access to care. Centring on protecting the vulnerable as informed by feminist (...) ethics scholarship, this paper argues that the failure to meet older people’s dependency needs is unjust, on the premise that it suggests a denial of the inherent value, rights and dignity of older people. This paper appeals for the provision of greater care and support by the state through putting in place social arrangements that better advance older people’s access to care. Some policy recommendations concerning health and social care reform for older people in rural China are also proposed. (shrink)

In China's healthcare sector, a popular and socio-culturally distinctive phenomenon known as guanxi jiuyi, whereby patients draw on their guanxi with physicians when seeking healthcare, is thriving. Integrating anthropological investigation with normative inquiry, this paper examines medical guanxi through the lens of patient–physician trust and mistrust. The first-hand empirical data acquired – on the lived experiences and perspectives of both patients and physicians – is based on six months' fieldwork carried out in a county hospital in Guangdong, southern China, which (...) included in-depth interviews with 20 patients and 20 medical professionals. Patients who emphasized the positive effects of guanxi on patient–physician trust believed that it facilitates access to experienced medical specialists, enhances clinical communication, and reduces the financial and medical risks of over diagnosis and overtreatment by physicians. At the same time, these findings reveal patients' strong sense of mistrust, not only towards individual health professionals but also to the medical profession and China's commercialized healthcare industry. While some health professionals in the study responded favourably to medical guanxi, most were opposed to it on the grounds that it undermines professional standards and equitable healthcare. We found that the practice of medical guanxi is not morally justifiable, chiefly because it reinforces the present high levels of patient–physician mistrust and erodes trust between patients and the medical profession as a whole. In China, both the medical profession and the state need to promote patient–physician trust based on medical professionalism and institutional norms, rather than on guanxi or individual relationships. (shrink)

Background:In China, the conventional family-based ageing care model is under pressure from social transitions, raising the question of whether and to what extent families are still capable of dealing with the care of the aged.Objective:This article examines the vulnerability and inadequacy of families to bear responsibility for the care of the aged against a backdrop of socioeconomic transformation and diminishing institutional support in rural China.Research design:This article adopts an empirical ethical approach that integrates empirical investigation with ethical inquiry.Participants and research (...) context:The empirical component of this article focuses on the lived experiences of caring for a wife and mother with dementia in one rural Chinese family, collected from a 6-month fieldwork study conducted at one primary hospital.Ethical considerations:Approval was obtained from the university ethics committee.Findings:The empirical study highlights a conflicted family process of managing and negotiating care that indicates the inadequacies and limited ability of families to deal with aged care tasks. In addition, inadequate structures and institutional deficiencies exacerbate the vulnerability of rural families and their inability to offer adequate care.Conclusion:Acknowledging the vulnerability of families as ageing care providers, this article calls for a socially supported family care model for rural older people in China and also proposes policy recommendations. (shrink)

Background:The pressing issue of aged care has made gendered caregiving a growing subject of feminist bioethical enquiry. However, the impact of feminism on empirical studies in the area of gendered care in Chinese sociocultural contexts has been less influential.Objectives:To examine female members’ lived experiences of gendered care in rural China and offer proper normative evaluation based on their experiences.Research design:This article adopted an empirical ethical approach that integrates ethnographical investigation and feminist ethical inquiry.Participants and research context:This article focused on three (...) cases of gendered caregiving for sick older members collected from a 6-month fieldwork conducted in a primary hospital in rural China.Ethical consideration:Approval was obtained from the university ethics committee.Findings:The empirical work highlights caregivers’ voices of weiqu (a sense of unfairness) resulting from their constrained choice when being pressured to engage in caregiving, which is associated with a disadvantageous socio-institutional and structural backdrop in current rural China. Informed by the conception of structural injustice, the normative analysis of this article traced various forms of social norms, structural deficiencies and ageing welfare institutions, as they intertwine and transmit into additional care deficiencies against rural families and their female caregivers.Conclusion:This article identified the constraint of gender hierarchy and its intersection with external social structure that exacerbate gendered oppression and exploitation of female labour in rural China. Normatively, this article argues that the current configuration of rural family care, featured by structural impediments and exploration of female labour, is unjust. Some policy recommendations are proposed to empower caregivers and advance care for rural older people. (shrink)

This paper examines caregiving for sick older family members in the context of socio‐economic transformations in rural China, combining empirical investigation with normative inquiry. The empirical part of this paper is based on a case study, taken from fieldwork in a rural Chinese hospital, of a son who took care of his hospitalized mother. This empirical study highlighted family members’ weiqu (sense of unfairness)—a mental status from experiencing mistreatment and oppression in family care, yet with constrained power to explicitly protest (...) or make care‐related choices. Underpinning people’s weiqu and constrained choice, as informed by the conception of structural injustice, is the impact of unjust social structures, organized by unfavourable norms, discriminatory social policies and institutions targeting rural populations. By restraining individual choices and capacities in supporting health care for aging populations, these unjust structures create additional difficulties for and discriminations against rural families and their older members. Some policy recommendations are proposed to mitigate structural injustice so as to empower families and promote care for older people in rural settings. (shrink)

While previous studies have suggested that there exists a relationship between obesity and executive function (EF), the mechanisms and causal relationship between them remain unclear. There are important clinical implications of determining whether EF can predict and treat obesity. We conducted a multilevel meta-analysis of randomized controlled trials (RCTs) and longitudinal studies. Specifically, we investigate (a) whether EF interventions have an effect on weight loss, (b) whether baseline EF can be a predictor of future weight loss through obesity intervention, and (...) (c) whether early-life EF can predict future weight loss. Eight RCTs and 17 longitudinal studies with a total of 11,393 participants were identified. We found that (a) EF interventions may not have an effect on weight loss, (b) baseline inhibition (β = 0.259,p= 0.03) and delay discounting (β = −0.17,p= 0.04) significantly predict future weight loss through obesity intervention, (c) age (F= 13.666,p= 0.005) moderates the relationship between working memory and weight loss through intervention, but not weight status, type of intervention, and percentage of female, and (d) early life inhibition (β = 0.185,p= 0.07) is a marginally significant predictor of future weight loss. Our results seem to support the assumption that the relationship between EF and obesity is not direct, and a higher-order factor, such as genes, may link obesity and EF. Building on the preliminary findings, further studies focusing on EF and obesity are needed in the future. (shrink)

ObjectivesWuhan is the city where coronavirus disease was first reported and developed into a pandemic. However, the impact of the prolonged COVID-19 pandemic on medical staff burnout remains limited. We aimed to identify the prevalence and major determinants of burnout among medical staff 1 year after the beginning of the COVID-19 pandemic in Wuhan, China.Materials and MethodsA total of 1,602 medical staff from three hospitals in Wuhan, China, were included from November 1–28, 2021. Chi-square tests were conducted to compare the (...) prevalence of burnout across groups based on sociodemographic and professional characteristics. A multivariate analysis was performed using a forward stepwise logistic regression model.ResultsApproximately 37.39% of the medical staff experienced burnout 1 year after COVID-19 pandemic. Emotional exhaustion was the most common symptom of burnout, with 1,422 participants reporting a severe EE. Burnout was associated with insufficient social support and “neutral” or “dissatisfied” patient-physician relationships. Respondents who participated in the care of COVID-19 patients had a higher risk of burnout symptoms than those who did not participate. In particular, mental resilience was negatively associated with burnout among the medical staff.ConclusionNearly two-fifths of the participants had symptoms of burnout, with reduced personal accomplishment being the predominant symptom 1 year after COVID-19. Healthcare organizations should regularly measure and monitor burnout among the medical staff. In addition, creating positive work environments and improving the mental resilience of medical staff may be effective ways to reduce burnout. (shrink)

本书从原则指导、规律制度、方法艺术、心理疏导和提高素质等五个方面,比较系统、完整而又深刻细致地分析了部队基层经常性思想工作。.

In lieu of an abstract, here is a brief excerpt of the content:The Crystal Order That Is Most Concrete:The Wittgenstein HouseHui Zou (bio)IntroductionIn the instruction of architectural history, some historical references have to be mentioned in terms of the relationship between building and language. In Chapter I, Book II, of The Ten Books on Architecture, the ancient Roman theorist Vitruvius discussed the "origin of the dwelling house." According to him, the "primitive hut" originated from the gathering of men around a (...) fire through communicating in language.1 In the primitive hut, the origin of architecture was co-presented with the origin of language; the language helped establish a harmonic relationship, which developed builders' construction collectivity. Such a language-collectivity relationship was witnessed in the record of the Tower of Babel in the biblical scripture where the Lord decided to stop the human beings' construction of the tower by "confus[ing] their language there."2 During the Renaissance, the alphabetic language and the design of buildings were correlated through the application of geometry that was supposed to embody the "divine proportion." In the Franciscan professor Luca Pacioli's book On Divine Proportion, letters of the alphabet were geometricized to become objects of contemplation for tracing "God's light."3 In Chinese gardens, there has been a long tradition of naming a specific view with a poetical phrase that thematicized the scene into a meaningful unity of the view and the viewer—jing.4 In all these historical cases, language and building were integrated into a cosmological picture grounded in divine transcendence.After the modernism in architectural history of the 1960s and 1970s, a loss of meaning in architecture was widely observed,5 and the interrelationship between language and architectural design began to emerge as a prominent issue. Several trends in architectural theories during the 1960s and 1970s studied how meaning was created through architectural design. One was the post-modern development in architecture that sought to apply classic architectural elements to the facades of new buildings as gestures to [End Page 22] the past.6 Another trend was phenomenological, which attempted to discover a common language of building contexts that led to building humanized living environments.7 Yet another trend was to apply linguistic approaches to the rational methodology of architectural analysis.8 The analogy of building with language was provoked by an impelling sense of the crisis that the traditional embodied order was being lost in the prevalent instrumentalized practice of architecture.The predicament of the loss of meaning in contemporary architecture can be traced as far back in philosophy as the splitting of mind and body proposed by René Descartes in the seventeenth century. This split began to distance architecture from its traditional embodiment of transcendental meanings in the second half of the eighteenth century9 and finally led to the division of the metaphysical and physical parts in modern architecture, especially after the industrialization of the nineteenth century. Correspondingly, language became an instrumental means for architecture to impose posterior "ideas" to the material bodies of buildings rather than acting as an inherent component of architectural design for the creation of meaning in architecture. The desire for meanings in modern architecture, based on the split of the metaphysical and physical, theoretically catered to linguistic research, such as semiotics, and tended to define architecture as a symbol. The linguistic structure of signifier-signified was, however, coarsely transplanted into architectural theory and reduced architectural symbolism to a simple dualism of idea and form in which the former was usually arbitrarily applied to the latter by a designer. Such an arbitrary imposition of external "meanings" onto an architectural form through language intensified their separation, which in turn produced nihilism in architecture.The lessons learned from the transplantation of linguistic studies into architectural theories remind us that we need to pay close attention to the historical events that could open up the interaction between language and building and reveal the "fundamental linguistic character of our experience of the world" in Gadamer's sense.10 A house designed and built by Austrian philosopher Ludwig Wittgenstein (1889-1951) provides a unique case for us to contemplate this issue. My historical study of the Wittgenstein House is not to understand Wittgenstein's subjective intentions... (shrink)

本书共有五章,内容包括精神科学的缘起、精神科学的体系、精神科学的基本对象、精神科学的认识逻辑、狄尔泰与现代西方哲学。.

Du Weiming xian sheng shi dang dai yan jiu he chuan bo ru jia wen hua de zhong yao si xiang jia. Ta 1940 nian chu sheng yu Kunming, xian hou qiu xue yu Taiwan dong hai da xue he Meiguo Hafo da xue, ren jiao yu Pulinsidun da xue, Bokeli Jiazhou da xue. Zi 1981 nian, Du Weiming xian sheng yi zhi zai Hafo da xue Dong Ya xi dan ren li shi ji zhe xue jiao shou,qi jian huo (...) xuan Meiguo ren wen she hui ke xue yuan yuan shi, hai ceng dan ren Hafo Yanjing xue she she zhang. Chang qi yi lai, Du Weiming xian sheng zhi li yu ru xue di 3 qi fa zhan, quan shi Zhongguo wen hua, fan si xian dai jing shen, chang dao wen ming dui hua, zai hai nei wai xiang you hen gao de xue shu sheng yu. Du xian sheng fei chang re xin Zhongguo you xiu chuan tong wen hua zai ben tu de chuan bo, duo ci hui guo can jia jiao yu he xue shu jiao liu huo dong. Ta yu Beijing da xue you zhe te shu de yuan fen,zao zai 1985 nian jiu lai Beijing da xue jiang shou ru jia zhe xue. Zui jin Du Weiming xian sheng yi zheng shi shou pin wei Beijing da xue gao deng ren wen yan jiu yuan yuan zhang. (shrink)

Zou Rong received a classical education but, uninterested in an official career and frustrated by the irrelevance of his schooling to the day's issues, traveled to Japan in 1901 to further his studies. There he wrote The Revolutionary Army, which was published in Shanghai after his return to China in 1903. The Revolutionary Army, which was scathingly critical of the Manchu rulers of China, enraged government authorities who sought his immediate arrest. Zou was protected by authorities of the International Settlement (...) in Shanghai, and eventually sentenced to only two years in jail. Be this as it may, Zou contracted an illness in prison and died in April of 1905. The Revolutionary Army is far more than an anti-Manchu racist tract. It advocates political and social revolution, and Zou's account of the justification for and goals of these revolutions rests in no small part on natural rights and independence, as discussed in the two chapters from the work that we translate here. (shrink)

本书是我国学者全面系统地阐述杜威学术思想的第一部专著,对杜威的哲学思想和教育思想做出实事求是的评价。.

《中國禮文化與儒學研究》通過對《禮記》《老子》《春秋》等儒家經典著作的研究，結合馬克思主義關於人類社會發展的相關理論，指出“禮”是中國文化的根基，強調了《禮記》在古禮研究中的價值和意義，探討了古禮的起 源以及先民的社會生活模式，並在此基礎上，對古禮的類別和結構、主要功能及其內在統一性進行了論述，分析了古禮的基本功能與中國文明形成道路的內在聯繫和重要意義。通過對《老子》的研究，分析了儒道之間的異同，並 闡述了老子思想的現代意義。通過分析儒家禮教思想與古代禮教的關係，探討了儒家禮教思想的人文價值，論述了儒家禮教思想與傳統政治制度的關係，提出《春秋》中的大一統思想是儒家學說中的外王思想，並探討了這種思想 在漢代大一統政治局面形成中的作用。.

In his recent works on daily face-to-face encounters, Zahavi claims that the phenomenon of sharing involves reciprocity. Following Zahavi’s line of thought, we wonder what exactly reciprocity amounts to and how the shared experience emerges from the dynamic process of interaction. By turning to the highly specialized field of elite sports dance, we aim at exploring the way in which reciprocity unfolds in intensive deliberate practices of movement. In our analysis, we specifically argue that the ongoing dynamics of two separate (...) flows of movement constitute a shared experience of dancing together. In this sense, moving together, in sports dance, is a practical way of understanding each other. In agreement with Zahavi, our analysis emphasizes the bi-directed nature of sharing. However, at the same time, we contribute to Zahavi’s ongoing endeavour as the special case of sports dance reveals how reciprocity can be deliberately shaped through the mutual coordination and affective bound dynamics of movement. Our article thus both pursues the methodological point that qualitative research of expert competences can constructively enrich phenomenological analysis and indicates how movement can be fundamental to the reciprocity of shared experience. (shrink)

Abstract In ?On Making an Effort? E. J. Coffman develops what he takes to be a fairly serious problem for Robert Kane's positive theory of free choice, where the concept of efforts of will is pivotal.1 Coffman argues that the plausibility of Kane's libertarian account of free choice ?is inversely proportional to the plausibility of a certain principle of agency? (p. 12). And since the latter is quite plausible, the former is therefore ?at best fairly implausible? (p. 12). In what (...) follows I will show that Coffman's objection is in fact misplaced. Kanean libertarianism not only is in accordance with the essence of the principles of personal responsibility that Coffman advocates, it also affords a more plausible and intelligible account of the sources of personal responsibility superior to the proposed principles. (shrink)

本書圍繞吳與弼哲學思想對陳獻章、王守仁的影響，及崇仁學派在整個明代哲學史所處的地位，展現崇仁學派儒家學者的理氣觀、心性論與道德修養論，凸顯十五世紀明代哲學史的真實面貌與內在理路，為理解陽明心學的興起提 供一種新的分析路徑。.

在宋儒學脈自二程至黃幹一系師承的啟發下，本書稿連續性地縱觀明儒學脈的師承進路，延著吳溥、楊溥—吳康齋—陳白沙—湛甘泉—唐一庵—許敬庵—劉念台不間斷的時間線索，圍繞明代諸儒的核心範疇與核心概念“至善性體 ”展開，試圖在陽明心學于明朝大瀾、大明與大傳播的框架外，找尋明儒學脈的新線索，發現有明一朝中國學術內在邏輯成長的新視野。.