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Both Canada and Singapore express support for—and have the reality of being—multi-cultural, multi-ethnic, and multi-religious; and both jurisdictions have an avowed commitment to the freedom of religion. Yet, this commitment expresses itself in different ways in these two contexts. Although both the Canadian Charter of Rights and Freedoms and the Singaporean Constitution guarantee the freedom of religion, juridical definitions of what this freedom means may differ quite profoundly.
This Article explores and analyzes these two different environments that nonetheless share important features. We argue that the approaches of Singapore and Canada do not fall simply into the categories of being “liberal” or “illiberal,” but instead invite reflection and reconsideration on the concepts of pluralism, secularism, and liberalism in interesting ways. This Article thus highlights the significance of contextual factors in understanding the ways in which religious diversity is dealt with, particularly in Canada and Singapore, but also more generally.
Porphyrinic compounds are of increasing interest to the materials science community, yet little attention has been paid to crystallographically controlled voids and channels in these materials. We have conducted an initial survey of the voids and channels in a random subset of 1000 porphyrinic compounds with known crystal structures. From calculations using a rolling-probe subroutine, we have found that about 5% of these compounds have line-of-sight channels, which differ in their topology depending on the crystallography. A small but significant number of porphyrinic compounds have calculated void contents of >25 volume %. We discuss in detail the void and channel characteristics, including pore-size distribution, of four representative compounds, with technological implications.
To enhance enrollment into randomized clinical trials (RCTs), we proposed electronic health record-based clinical decision support for patient–clinician shared decision-making about care and RCT enrollment, based on “mathematical equipoise.”
As an example, we created the Knee Osteoarthritis Mathematical Equipoise Tool (KOMET) to determine the presence of patient-specific equipoise between treatments for the choice between total knee replacement (TKR) and nonsurgical treatment of advanced knee osteoarthritis.
With input from patients and clinicians about important pain and physical function treatment outcomes, we created a database from non-RCT sources of knee osteoarthritis outcomes. We then developed multivariable linear regression models that predict 1-year individual-patient knee pain and physical function outcomes for TKR and for nonsurgical treatment. These predictions allowed detecting mathematical equipoise between these two options for patients eligible for TKR. Decision support software was developed to graphically illustrate, for a given patient, the degree of overlap of pain and functional outcomes between the treatments and was pilot tested for usability, responsiveness, and as support for shared decision-making.
The KOMET predictive regression model for knee pain had four patient-specific variables, and an r2 value of 0.32, and the model for physical functioning included six patient-specific variables, and an r2 of 0.34. These models were incorporated into prototype KOMET decision support software and pilot tested in clinics, and were generally well received.
Use of predictive models and mathematical equipoise may help discern patient-specific equipoise to support shared decision-making for selecting between alternative treatments and considering enrollment into an RCT.
Motivated by the success of wavepackets in modelling the noise from subsonic and perfectly expanded supersonic jets, we apply the wavepacket model to imperfectly expanded supersonic jets. Recent studies with subsonic jets have demonstrated the importance of capturing the ‘jitter’ of wavepackets in order to correctly predict the intensity of far-field sound. Wavepacket jitter may be statistically represented using a two-point coherence function; accurate prediction of noise requires identification of this coherence function. Following the analysis of Cavalieri & Agarwal (J. Fluid Mech., vol. 748, 2014. pp. 399–415), we extend their methodology to model the acoustic sources of broadband shock-associated noise in imperfectly expanded supersonic jets using cross-spectral densities of the turbulent and shock-cell quantities. The aim is to determine the relationship between wavepacket coherence-decay and far-field broadband shock-associated noise, using the model as a vehicle to explore the flow mechanisms at work. Unlike the subsonic case where inclusion of coherence decay amplifies the sound pressure level over the whole acoustic spectrum, we find that it does not play such a critical role in determining the peak sound amplitude for shock-cell noise. When higher-order shock-cell modes are used to reconstruct the acoustic spectrum at higher frequencies, however, the inclusion of a jittering wavepacket is necessary. These results suggest that the requirement for coherence decay identified in prior broadband shock-associated noise (BBSAN) models is in reality the statistical signature of jittering wavepackets. The results from this modelling approach suggest that nonlinear jittering effects of wavepackets need to be included in dynamic models for broadband shock-associated noise.
To understand the relationship between place and politics, we must measure both political attitudes and the ways in which place is represented in the minds of individuals. In this paper, we assess a new measure of mental representation of geography, in which survey respondents draw their own local communities on maps and describe them. We use a panel study in Canada to present evidence that these maps are both valid and reliable measures of a personally relevant geographic area, laying the measurement groundwork for the growing number of studies using this technology. We hope to set efforts to measure “place” for the study of context and politics on firmer footing. Our validity assessments show that individuals are thinking about people and places with which they have regular contact when asked to draw their communities. Our reliability assessments show that people can draw more or less the same map twice, even when the exercise is repeated months later. Finally, we provide evidence that the concept of community is a tangible consideration in the minds of ordinary citizens and is not simply a normative aspiration or motivation.
To investigate the prevalence and predictors of expressed breast-milk feeding in healthy full-term infants and its association with total duration of breast-milk feeding.
Prospective cohort study.
In-patient postnatal units of four public hospitals in Hong Kong.
A total of 2450 mother–infant pairs were recruited in 2006–2007 and 2011–2012 and followed up prospectively for 12 months or until breast-milk feeding had stopped.
Across the first 6 months postpartum, the rate of exclusive expressed breast-milk feeding ranged from 5·1 to 8·0 % in 2006–2007 and from 18·0 to 19·8 % in 2011–2012. Factors associated with higher rate of exclusive expressed breast-milk feeding included supplementation with infant formula, lack of previous breast-milk feeding experience, having a planned caesarean section delivery and returning to work postpartum. Exclusive expressed breast-milk feeding was associated with an increased risk of early breast-milk feeding cessation when compared with direct feeding at the breast. The hazard ratio (95 % CI) ranged from 1·25 (1·04, 1·51) to 1·91 (1·34, 2·73) across the first 6 months.
Mothers of healthy term infants should be encouraged and supported to feed directly at the breast. Exclusive expressed breast-milk feeding should be recommended only when medically necessary and not as a substitute for feeding directly at the breast. Further research is required to explore mothers’ reasons for exclusive expressed breast-milk feeding and to identify the health outcomes associated with this practice.
To investigate the effect of public hospitals in Hong Kong not accepting free infant formula from manufacturers on in-hospital formula supplementation rates and breast-feeding duration.
Prospective cohort study.
In-patient postnatal units of four public hospitals in Hong Kong.
Two cohorts of breast-feeding mother–infant pairs (n 2560). Cohort 1 (n 1320) was recruited before implementation of the policy to stop accepting free infant formula and cohort 2 (n 1240) was recruited after policy implementation. Participants were followed prospectively for 12 months or until they stopped breast-feeding.
The mean number of formula supplements given to infants in the first 24 h was 2·70 (sd 3·11) in cohort 1 and 1·17 (sd 1·94) in cohort 2 (P<0·001). The proportion of infants who were exclusively breast-fed during the hospital stay increased from 17·7 % in cohort 1 to 41·3 % in cohort 2 (P<0·001) and the risk of breast-feeding cessation was significantly lower in cohort 2 (hazard ratio=0·81; 95 % CI 0·73, 0·90). Participants who non-exclusively breast-fed during the hospital stay had a significantly higher risk of stopping any or exclusive breast-feeding. Higher levels of formula supplementation also increased the risk of breast-feeding cessation in a dose–response pattern.
After implementation of a hospital policy to pay market price for infant formula, rates of in-hospital formula supplementation were reduced and the rates of in-hospital exclusive breast-feeding and breast-feeding duration increased.
Research on paranoia in adults suggests a spectrum of severity, but this
dimensional approach has yet to be applied to children or to groups from
To investigate the structure, prevalence and correlates of mistrust in
children living in the UK and Hong Kong.
Children aged 8–14 years from the UK (n = 1086) and Hong
Kong (n = 1412) completed a newly developed mistrust
questionnaire as well as standard questionnaire measures of anxiety,
self-esteem, aggression and callous–unemotional traits.
Confirmatory factor analysis of the UK data supported a three-factor
model – mistrust at home, mistrust at school and general mistrust – with
a clear positive skew in the data: just 3.4%, 8.5% and 4.1% of the
children endorsed at least half of the mistrust items for home, school
and general subscales respectively. These findings were replicated in
Hong Kong. Moreover, compared with their peers, ‘mistrustful’ children
(in both countries) reported elevated rates of anxiety, low self-esteem,
aggression and callous–unemotional traits.
Mistrust may exist as a quantitative trait in children, which, as in
adults, is associated with elevated risks of internalising and
The provision of medical care in environments with high levels of ambient noise (HLAN), such as concerts or sporting events, presents unique communication challenges. Audio transmissions can be incomprehensible to the receivers. Text-based communications may be a valuable primary and/or secondary means of communication in this type of setting.
To evaluate the usability of text-based communications in parallel with standard two-way radio communications during mass-gathering (MG) events in the context of HLAN.
This Canadian study used outcome survey methods to evaluate the performance of communication devices during MG events. Ten standard commercially available handheld smart phones loaded with basic voice and data plans were assigned to health care providers (HCPs) for use as an adjunct to the medical team's typical radio-based communication. Common text messaging and chat platforms were trialed. Both efficacy and provider satisfaction were evaluated.
During a 23-month period, the smart phones were deployed at 17 events with HLAN for a total of 40 event days or approximately 460 hours of active use. Survey responses from health care providers (177) and dispatchers (26) were analyzed. The response rate was unknown due to the method of recruitment. Of the 155 HCP responses to the question measuring difficulty of communication in environments with HLAN, 68.4% agreed that they “occasionally” or “frequently” found it difficult to clearly understand voice communications via two-way radio. Similarly, of the 23 dispatcher responses to the same item, 65.2% of the responses indicated that “occasionally” or “frequently” HLAN negatively affected the ability to communicate clearly with team members. Of the 168 HCP responses to the item assessing whether text-based communication improved the ability to understand and respond to calls when compared to radio alone, 86.3% “agreed” or “strongly agreed” that this was the case. The dispatcher responses (n = 21) to the same item also “agreed” or “strongly agreed” that this was the case 95.5% of the time.
The use of smart phone technology for text-based communications is a practical and feasible tool for MG events and should be explored further. Multiple, reliable, discrete forms of communication technology are pivotal to executing effective on-site medical and disaster responses.
LundA, WongD, LewisK, TurrisSA, VaislerS, GutmanS. Text Messaging as a Strategy to Address the Limits of Audio-Based Communication During Mass-Gathering Events with High Ambient Noise. Prehosp Disaster Med.2013;28(1):1-7.
We have performed a survey study of rotational excited-state H2 Lyman-Werner absorption lines in the entire FUSE Magellanic Clouds Legacy archive. These lines reflect the UV pumping and formation conditions of H2, enabling a more comprehensive study of H2 gas properties, e.g. J-level populations N(J) and b-values (generally indicating the velocity dispersion). Combining with our previous measurements of N(Hi) and N(H2), we derived H2 excitation temperatures, gas volume density n(H), and local UV radiation field strength IUV for each sight line. The results indicate a weaker correlation between n(H) and IUV in Magellanic Clouds than the Galactic sight lines. We also obtained N(H)/E(B − V) ratios from the Spitzer-SAGE and previous CO J = 1 − 0 / Hi 21 cm surveys at sight line locations, using dust modeling and standard line brightness-column density conversion factors. They show a roughly linear correlation with absorption-based N(H)/E(B − V) values, and have a similar scatter (∼0.7 dex) across the LMC and SMC.
Compound semiconductors belong to the most important materials for optoelectronic applications. Many of them exhibit favorable optical properties, such as a direct energy band gap (in contrast to silicon) and high-absorption coefficients over a wide spectral range. Moreover, varying the composition of the compound or substituting some of its elements often allows for controlled band gap engineering and optimization for specific applications. Because many compound semiconductors enable efficient conversion of light into electricity and vice versa, they are commonly used materials for optoelectronic devices.
To evaluate the impact of postprescription review of broad-spectrum antimicrobial (study-ABX) agents on rates of antimicrobial use.
Quasi-experimental before-after study.
Five academic medical centers.
Adults receiving at least 48 hours of study-ABX.
The baseline, intervention, and follow-up periods were 6 months each in 2 units at each of 5 sites. Adults receiving at least 48 hours of study-ABX entered the cohort as case-patients. During the intervention, infectious-diseases physicians reviewed the cases after 48 hours of study-ABX. The provider was contacted with alternative recommendations if antimicrobial use was considered to be unjustified on the basis of predetermined criteria. Acceptance rates were assessed 48 hours later. The primary outcome measure was days of study-ABX per 1,000 study-patient-days in the baseline and intervention periods.
There were 1,265 patients in the baseline period and 1,163 patients in the intervention period. Study-ABX use decreased significantly during the intervention period at 2 sites: from 574.4 to 533.8 study-ABX days/1,000 patient-days (incidence rate ratio [IRR], 0.93; 95% confidence interval [CI], 0.88-0.97; P = .002) at hospital В and from 615.6 to 514.4 study-ABX days/1,000 patient-days (IRR, 0.83; 95% CI, 0.79-0.88; P < .001) at hospital D. Both had established antimicrobial stewardship programs (ASP). Study-ABX use increased at 2 sites and stayed the same at 1 site. At all institutions combined, 390 of 1,429 (27.3%) study-ABX courses were assessed as unjustified; recommendations to modify or stop therapy were accepted for 260 (66.7%) of these courses.
Postprescription review of study-ABX decreased antimicrobial utilization in some of the study hospitals and may be more effective when performed as part of an established ASP.