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This chapter examines the current semi-normative framework for advance healthcare directives and related practice and discussion in China’s mainland. Without specified legislation acknowledging binding advance healthcare directives, China’s new Civil Code (2021) adopts legal criteria for a person to be deemed lacking in decision-making capacity and for the appointment of substitute decision makers for them. The Code of Ethics (2014) of the Chinese Medical Doctor Association requires Chinese medical practitioners to respect the expressed will of patients when they are capable of making decisions and to ensure patients’ maximum participation in the decision-making process even when they are considered to lack capacity. This chapter presents a doctrinal understanding of such a framework of norms that may potentially affect practices relating to advance healthcare directives. However, the existing evidence reflected by judicial proceedings and medical research papers suggests that the framework has rarely, if ever, been translated into medical practice. The chapter considers the possible legal and social explanations for such a lack of implementation. It also surveys a number of civil society-led pilot projects that promote advance healthcare directives, presenting a wider landscape of the relevant practice in China’s mainland.
The Nanjing Bao'ensi site is the largest and highest-ranking royal temple from the Ming Dynasty, and it is famous for its full-body glass pagoda. In this study, the glazed tiles excavated from the southern area of the Bao'ensi site were selected and analysed using X-ray diffraction, thermal dilation and energy-dispersive X-ray fluorescence to determine their phase composition, firing temperature and chemical composition. The glazed tile bodies of the Bao'ensi site consist mainly of quartz and mullite, although some samples contain trace amounts of other minerals. All of the body samples were fired to the same temperature range (i.e. 1000–1100°C). The firing temperature combined with the phase composition indicate that the raw materials and firing process of the glazed tile body samples have similarities, but there are certain differences. The source of the raw materials for a portion of the glazed tile bodies is Dangtu, Anhui, whilst the source of the raw materials for the remaining materials remains to be discovered.
In dynamic outdoor environments characterized by turbulent airflow and intermittent odor plumes, robotic odor plume tracking remains challenging, because existing algorithms heavily rely on manually tuning or learning from expert experience, which are hard to implement in an unknown environment. In this paper, a multi-continuous-output Takagi–Sugeno–Kang fuzzy system was designed and tuned with reinforcement learning to solve the robotic odor source localization problem in dynamic odor plumes. Based on the Lévy Taxis plume tracking controller, the proposed fuzzy system determined the parameters of the controller based on the robot’s observation and guided the robot to turn and move towards the odor source at each searching step. The trained fuzzy system was tested in simulated filament-based odor plumes dispersed by a changing wind field. The results showed that the performance of the proposed fuzzy system-based controller trained with reinforcement learning can achieve a similar success rate and higher efficiency compared with a manually tuned and well-designed fuzzy system-based controller. The fuzzy system-based plume tracking controller was also validated through real robotic experiments.
Studies have shown that people with internet gaming disorder (IGD) exhibit impaired executive control of gaming cravings; however, the neural mechanisms underlying this process remain unknown. In addition, these conclusions were based on the hypothesis that brain networks are temporally static, neglecting dynamic changes in cognitive processes.
Methods
Resting-state fMRI data were collected from 402 subjects [162 subjects with IGD and 240 recreational game users (RGUs)]. The community structure (recruitment and integration) of the executive control network (ECN) and the basal ganglia network (BGN), which represents the reward network, of patients with IGD and RGUs were compared. Mediation effects among the different networks were analyzed.
Results
Compared to RGUs, subjects with IGD had a lower recruitment coefficient within the right ECN. Further analysis showed that only male subjects had a lower recruitment coefficient. Mediation analysis showed that the integration coefficient of the right ECN mediated the relationship between the recruitment coefficients of both the right ECN and the BGN in RGUs.
Conclusions
Male subjects with IGD had a lower recruitment coefficient than RGUs, which impairing their impulse control. The mediation results suggest that top-down executive control of the ECN is absent in subjects with IGD. Together, these findings could explain why subjects with IGD exhibit impaired executive control of gaming cravings; these results have important therapeutic implications for developing effective interventions for IGD.
Numerous technologies have contributed to the recent development of agriculture, especially the advancement in hyperspectral remote sensing (HRS) constituted a revolution in crop monitoring. The widespread use of HRS to obtain crop parameters suggests the need for a review of research advances in this area. HRS offers new theories and methods for studying crop parameters, but much work needs to be done both experimentally and theoretically before we can truly understand the physical and chemical processes that predict these crop parameters. The study focuses on the following elements: 1) The article provides a relatively comprehensive introduction to HRS and how it can be applied to crop monitoring; 2) Current state-of-the-art techniques are summarized and analyzed to inform further advances in crop monitoring; 3) Opportunities and challenges for crop monitoring applications using HRS are discussed, and future research is summarized. Finally, through a comprehensive discussion and analysis, the article proposes new directions for using HRS to study crop characteristics, such as new data mining techniques including deep learning provide opportunities for efficient processing of large amounts of HRS data; combining the temporal and dynamic characteristics of crop parameters and vegetation growth processes will greatly improve the accuracy of crop parameter detection and monitoring; multidata fusion and multiscale data assimilation will become HRS monitoring. Multidata fusion and multiscale data assimilation will become another research hotspot for HRS monitoring of crop parameters.
Due to the lack of research between the inner layers in the structure of colonic mucous and the metabolism of fatty acid in the constipation model, we aim to determine the changes in the mucous phenotype of the colonic glycocalyx and the microbial community structure following treatment with Rhubarb extract in our research. The constipation and treatment models are generated using adult male C57BL/6N mice. We perform light microscopy and transmission electron microscopy (TEM) to detect a Muc2-rich inner mucus layer attached to mice colon under different conditions. In addition, 16S rDNA sequencing is performed to examine the intestinal flora. According to TEM images, we demonstrate that Rhubarb can promote mucin secretion and find direct evidence of dendritic structure-linked mucus structures with its assembly into a lamellar network in a pore size distribution in the isolated colon section. Moreover, the diversity of intestinal flora has noticeable changes in constipated mice. The present study characterizes a dendritic structure and persistent cross-links have significant changes accompanied by the alteration of intestinal flora in feces in models of constipation and pretreatment with Rhubarb extract.
Recently, the nature of viscoelastic drag-reducing turbulence (DRT), especially the maximum drag reduction (MDR) state, has become a focus of controversy. It has long been regarded as polymer-modulated inertial turbulence (IT), but is challenged by the newly proposed concept of elasto-inertial turbulence (EIT). This study is to repicture DRT in parallel plane channels by introducing dynamics of EIT through statistical, structural and budget analysis for a series of flow regimes from the onset of drag reduction to EIT. Some underlying mechanistic links between DRT and EIT are revealed. Energy conversion between velocity fluctuations and polymers as well as pressure redistribution effects are of particular concern, based on which a new energy self-sustaining process (SSP) of DRT is repictured. The numerical results indicate that at low Reynolds number ($Re$), weak IT flow is replaced by a laminar regime before the barrier of EIT dynamics is established with the increase of elasticity, whereas, at moderate $Re$, EIT-related SSP can get involved and survive from being relaminarized. This further explains the reason why relaminarization phenomenon is observed for low $Re$ while the flow directly enters MDR and EIT at moderate $Re$. Moreover, with the proposed energy picture, the newly discovered phenomenon that streamwise velocity fluctuations lag behind those in the wall-normal direction can be well explained. The repictured SSP certainly justifies the conjecture that IT nature is gradually replaced by that of EIT in DRT with the increase of elasticity.
Little is known about how sociodemographic and clinical factors affect the caregiving burden of persons with schizophrenia (PwSs) with transition in primary caregivers.
Aims
This study aimed to examine the predictive effects of sociodemographic and clinical factors on the caregiving burden of PwSs with and without caregiver transition from 1994 to 2015 in rural China.
Method
Using panel data, 206 dyads of PwSs and their primary caregivers were investigated in both 1994 and 2015. The generalised linear model approach was used to examine the predictive effects of sociodemographic factors, severity of symptoms and changes in social functioning on the caregiving burden with and without caregiver transition.
Results
The percentages of families with and without caregiver transition were 38.8% and 61.2%, respectively. Among families without caregiver transition, a heavier burden was significantly related to a larger family size and more severe symptoms in PwSs. Deteriorated functioning of ‘social activities outside the household’ and improved functioning of ‘activity in the household’ were protective factors against a heavy caregiving burden. Among families with caregiver transition, younger age, improved marital functioning, deteriorated self-care functioning, and better functioning of ‘social interest or concern’ were significant risk factors for caregiving burden.
Conclusions
The effects of sociodemographic and clinical correlates on the caregiving burden were different among families with and without caregiver transition. It is crucial to explore the caregiver arrangement of PwSs and the risk factors for burden over time, which will facilitate culture-specific family interventions, community-based mental health services and recovery.
Listeriosis is a rare but serious foodborne disease caused by Listeria monocytogenes. This matched case–control study (1:1 ratio) aimed to identify the risk factors associated with food consumption and food-handling habits for the occurrence of sporadic listeriosis in Beijing, China. Cases were defined as patients from whom Listeria was isolated, in addition to the presence of symptoms, including fever, bacteraemia, sepsis and other clinical manifestations corresponding to listeriosis, which were reported via the Beijing Foodborne Disease Surveillance System. Basic patient information and possible risk factors associated with food consumption and food-handling habits were collected through face-to-face interviews. One hundred and six cases were enrolled from 1 January 2018 to 31 December 2020, including 52 perinatal cases and 54 non-perinatal cases. In the non-perinatal group, the consumption of Chinese cold dishes increased the risk of infection by 3.43-fold (95% confidence interval 1.27–9.25, χ2 = 5.92, P = 0.02). In the perinatal group, the risk of infection reduced by 95.2% when raw and cooked foods were well-separated (χ2 = 5.11, P = 0.02). These findings provide important scientific evidence for preventing infection by L. monocytogenes and improving the dissemination of advice regarding food safety for vulnerable populations.
This research communication aims to characterize the prevalence, molecular characterization and antimicrobial resistance profiling of Streptococcus agalactiae isolated from clinical mastitis in China. A total of 140 Strep. agalactiae isolates were identified from 12 out of 201 farms in 6 provinces, overall herd prevalence was 18.6% and the MLST analysis showed clonal complexes (CC) 103 and CC 67 were present in these herds with CC 103 predominant, accounting for 97.9%. Isolates were mostly sensitive to the tested antimicrobials: penicillin, ceftiofur, amoxi/clav, cefquinome, and vancomycin (100%), followed by cefalexin (97.9%), oxacillin (96.4%), enrofloxacin (95.7%), erythromycin (89.3%), and clindamycin (88.6%). Only 19.3 and 0.7% of isolates were sensitive to tetracycline and daptomycin, respectively, and sequence type (ST) 103 was most resistant to antimicrobials. In conclusion, CC 103 was the predominant subgroup of bovine mastitis Strep. agalactiae in China, and most antimicrobials apart from tetracycline and daptomycin were effective.
At present, the study on autonomous unmanned ground vehicle navigation in an unstructured environment is still facing great challenges and is of great significance in scenarios where search and rescue robots, planetary exploration robots, and agricultural robots are needed. In this paper, we proposed an autonomous navigation method for unstructured environments based on terrain constraints. Efficient path search and trajectory optimization on octree map are proposed to generate trajectories, which can effectively avoid various obstacles in off-road environments, such as dynamic obstacles and negative obstacles, to reach the specified destination. We have conducted empirical experiments in both simulated and real environments, and the results show that our approach achieved superior performance in dynamic obstacle avoidance tasks and mapless navigation tasks compared to the traditional 2-dimensional or 2.5-dimensional navigation methods.
To satisfy the increasing requirements of wireless communication, a compact dual band MIMO antenna is presented in this paper. The presented antenna consists of two symmetric radiating elements operating at both 3.5 and 4.5 GHz bands. To enhance the isolation between the two radiating elements, an I-shaped decoupling structure is introduced. The measured −10 dB reflection coefficients frequency bands are 3.3–3.8 and 4.3–5.8 GHz. The measured isolation S21 between the two radiating elements are better than 15 and 17 dB at the lower and higher frequency band, respectively. The overall dimension of the proposed antenna is 50 × 22 × 1.59 mm3. The measured result indicates that the proposed antenna can be a good candidate for 5 G/WLAN wireless communication.
Hyperinsulinaemia and insulin resistance have been proposed to be associated with mortality risk, and diet can modulate insulin response. However, whether dietary patterns with high insulinaemic potential are associated with mortality remains unknown. We prospectively examined the associations between hyperinsulinaemic diets and the risk of total and cause-specific mortality in a large nationally representative population. Dietary factors were assessed by 24-h recalls. Two empirical dietary indices for hyperinsulinaemia (EDIH) and insulin resistance (EDIR) were developed to identify food groups most predictive of biomarkers for hyperinsulinaemia (C-peptide and insulin) and insulin resistance (homoeostatic model assessment for insulin resistance), respectively. Deaths from date of the first dietary interview until 31 December 2015 were identified by the National Death Index. Multivariable hazard ratios (HR) and 95 % CI were calculated using Cox regression models. During a median follow-up of 7·8 years, 4904 deaths were documented among 40 074 participants. For EDIH, the multivariable-adjusted HR (comparing extreme quintiles) were 1·20 (95 % CI 1·09, 1·32, P-trend<0·001) for overall mortality and 1·41 (95 % CI 1·15, 1·74, P-trend = 0·002) for CVD mortality. Similar associations were observed for EDIR with HR of 1·18 (95 % CI 1·07, 1·29, P-trend < 0·001) for total and 1·35 (95 % CI 1·09, 1·67, P-trend = 0·005) for CVD mortality. After further adjustments for BMI and diabetes, these positive associations were somewhat attenuated. Our findings suggested that diets with higher insulinaemic potential are associated with increased risk of overall and CVD-specific mortality.
The Lochkovian (Lower Devonian) conodont biostratigraphy in China is poorly known, and conodont-based subdivision schemes for the Lochkovian in peri-Gondwana (the Spanish Central Pyrenees, the Prague Synform, Sardinia, and the Carnic Alps) have not been tested in China. Therefore, we studied conodonts from the lower part (Bed 9 to Bed 13) of the Shanjiang Formation at the Alengchu section of Lijiang, western Yunnan to test the application of established subdivision schemes. The conodont fauna is assignable to 12 taxa belonging to eight genera (Ancyrodelloides, Flajsella, Lanea, Wurmiella, Zieglerodina, Caudicriodus, Pelekysgnathus, and Pseudooneotodus), and enables recognition of two chronostratigraphical intervals from the lower part of the Shanjiang Formation. The interval ranging from the uppermost part of Bed 9 to the upper part of Bed 10 belongs to the lower Lochkovian; whereas an interval covering the uppermost part of Bed 11 to the upper part of Bed 13 is correlated with the upper half of the middle Lochkovian. The Silurian-Devonian boundary is probably located within Bed 9, in the basal part of the Shanjiang Formation. However, the scarcity of specimens precludes definitive identification of bases of the lower, middle, and upper Lochkovian as well as other conodont zones recognized in peri-Gondwana.
Laser–plasma accelerators (LPAs) have great potential to realize a compact X-ray free-electron laser (FEL), which is limited by the beam properties currently. Two-color high-intensity X-ray FEL provides a powerful tool for probing ultrafast dynamic systems. In this paper, we present a simple and feasible method to generate a two-color X-ray FEL pulse based on an LPA beam. In this scheme, time-dependent mismatch along the bunch is generated and manipulated by the designed lattice system, enabling FEL lasing at different wavelength within two undulator sections. The time separation between the two pulses can be precisely adjusted by varying the time-delay chicane. Numerical simulations show that two-color soft X-ray FELs with gigawatt-level peak power and femtosecond duration can be generated, which confirm the validity and feasibility of the scheme.
The mechanisms of leading-edge vortex (LEV) formation and its stable attachment to revolving wings depend highly on Reynolds number ($\textit {Re}$). In this study, using numerical methods, we examined the $\textit {Re}$ dependence of LEV formation dynamics and stability on revolving wings with $\textit {Re}$ ranging from 10 to 5000. Our results show that the duration of the LEV formation period and its steady-state intensity both reduce significantly as $\textit {Re}$ decreases from 1000 to 10. Moreover, the primary mechanisms contributing to LEV stability can vary at different $\textit {Re}$ levels. At $\textit {Re} <200$, the LEV stability is mainly driven by viscous diffusion. At $200<\textit {Re} <1000$, the LEV is maintained by two distinct vortex-tilting-based mechanisms, i.e. the planetary vorticity tilting and the radial–tangential vorticity balance. At $\textit {Re}>1000$, the radial–tangential vorticity balance becomes the primary contributor to LEV stability, in addition to secondary contributions from tip-ward vorticity convection, vortex compression and planetary vorticity tilting. It is further shown that the regions of tip-ward vorticity convection and tip-ward pressure gradient almost overlap at high $\textit {Re}$. In addition, the contribution of planetary vorticity tilting in LEV stability is $\textit {Re}$-independent. This work provides novel insights into the various mechanisms, in particular those of vortex tilting, in driving the LEV formation and stability on low-$\textit {Re}$ revolving wings.
Nutritional Risk Screening index is a standard tool to assess nutritional risk, but epidemiological data are scarce on controlling nutritional status (CONUT) as a prognostic marker in acute haemorrhagic stroke (AHS). We aimed to explore whether the CONUT may predict a 3-month functional outcome in AHS. In total, 349 Chinese patients with incident AHS were consecutively recruited, and their malnutrition risks were determined using a high CONUT score of ≥ 2. The cohort patients were divided into high-CONUT (≥ 2) and low-CONUT (< 2) groups, and primary outcomes were a poor functional prognosis defined as the modified Rankin Scale (mRS) score of ≥ 3 at post-discharge for 3 months. Odds ratios (OR) with 95 % confidence intervals (CI) for the poor functional prognosis at post-discharge were estimated by using a logistic analysis with additional adjustments for unbalanced variables between the high-CONUT and low-CONUT groups. A total of 328 patients (60·38 ± 12·83 years; 66·77 % male) completed the mRS assessment at post-discharge for 3 months, with 172 patients at malnutrition risk at admission and 104 patients with a poor prognosis. The levels of total cholesterol and total lymphocyte counts were significantly lower in high-CONUT patients than low-CONUT patients (P = 0·012 and < 0·001, respectively). At 3-month post discharge, there was a greater risk for the poor outcome in the high-CONUT compared with the low-CONUT patients at admission (OR: 2·32, 95 % CI: 1·28, 4·17). High-CONUT scores independently predict a 3-month poor prognosis in AHS, which helps to identify those who need additional nutritional managements.
The effect of vitamin D (VD) on the risk of preeclampsia (PE) is uncertain. Few of previous studies focused on the relationship between dietary VD intake and PE risk. Therefore, we conducted this 1:1 matched case–control study to explore the association of dietary VD intake and serum VD concentrations with PE risk in Chinese pregnant women. A total of 440 pairs of participants were recruited during March 2016 to June 2019. Dietary information was obtained using a seventy-eight-item semi-quantitative FFQ. Serum concentrations of 25(OH)D2 and 25(OH)D3 were measured by liquid chromatography–tandem MS. Multivariate conditional logistic regression was used to estimate OR and 95 % CI. Restricted cubic splines (RCS) were plotted to evaluate the dose–response relationship of dietary VD intake and serum VD concentrations with PE risk. Compared with the lowest quartile, the OR of the highest quartile were 0·45 (95 % CI 0·29, 0·71, Ptrend = 0·001) for VD dietary intake and 0·26 (95 % CI 0·11, 0·60, Ptrend = 0·003) for serum levels after adjusting for confounders. In addition, the RCS analysis suggested a reverse J-shaped relationship between dietary VD intake and PE risk (P-nonlinearity = 0·02). A similar association was also found between serum concentrations of total 25(OH)D and PE risk (P-nonlinearity = 0·02). In conclusion, this study provides evidence that higher dietary intake and serum levels of VD are associated with the lower risk of PE in Chinese pregnant women.
Inflammation is a central mechanism in metabolic disorders associated with morbidity and mortality and dietary factors can modulate inflammation. We aimed to prospectively investigate the association between an empirically developed, food-based dietary inflammatory pattern (EDIP) score and the risk of overall and cause-specific mortality, using data from the US National Health and Nutrition Examination Survey from 1999 to 2014. EDIP score was derived by entering thirty-nine predefined commonly consumed food groups into the reduced rank regression models followed by stepwise linear regression, which was most predictive of two plasma inflammation biomarkers including C-reactive protein and leucocyte count among 25 500 US adults. This score was further validated in a testing set of 9466 adults. Deaths from baseline until 31 December 2015 were identified through record linkage to the National Death Index. During a median follow-up of 7·8 years among 40 074 participants, we documented 4904 deaths. Compared with participants in the lowest quintile of EDIP score, those in the highest quintile had a higher risk of overall death (hazard ratio (HR) = 1·19, 95 % CI 1·08, 1·32, Ptrend = 0·002), and deaths from cancer (HR = 1·41, 95 % CI 1·14, 1·74, Ptrend = 0·017) and CVD (HR = 1·22, 95 % CI 0·98, 1·53, Ptrend = 0·211). When stratified by age, the association of EDIP with overall mortality was stronger among individuals under 65 years of age (Pinteraction = 0·001). Diets with a higher inflammatory potential were associated with increased risk of overall and cancer-specific mortality. Interventions to reduce the adverse effect of pro-inflammatory diets may potentially promote health and longevity.
The density–depth relationship of the Antarctic ice sheet is important for establishing a high-precision surface mass balance model and predicting future ice-sheet contributions to global sea levels. A new algorithm is used to reconstruct firn density and densification rate by inverting monostatic radio wave echoes from ground-operated frequency-modulated continuous wave radar data collected near four ice cores along the transect from Zhongshan Station to Dome A. The inverted density profile is consistent with the core data within 5.54% root mean square error. Due to snow redistribution, the densification rate within 88 km of ice core DT401 is correlated with the accumulation rate and varies greatly over horizontal distances of <5 km. That is, the depth at which a critical density of 830 kg m−3 is reached decreases and densification rate increases in high-accumulation regions but decreases in low-accumulation regions. This inversion technique can be used to analyse more Antarctic radar data and obtain the density distribution trend, which can improve the accuracy of mass-balance estimations.