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This study examined the contribution of long-term use of Lipiodol capsules, as a supplement to iodised salt to the control of iodine deficiency disorders among women in Xinjiang of China. A total of 1220 women across Kashgar, Aksu, Turpan and Yili Prefectures were surveyed in 2017. Lipiodol capsules were administered twice yearly in Kashgar and once yearly in Aksu and Turpan, but not in Yili. Urinary iodine concentration (UIC), free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), thyroglobulin antibody, thyroid peroxidase antibody and thyroid volume values were assessed. All the women in the four areas were in a state of non-iodine deficiency by UIC. The UIC were higher than adequate in Kashgar and Aksu (619·4 v. 278·6 μg/l). Thyroid hormone levels differed significantly in Turpan and Yili (FT3: 4·4 v. 4·6 pmol/l, FT4: 13·8 v. 14·2 pmol/l, TSH: 2·0 v. 2·7 mIU/l), but did not differ significantly in Kashgar, Aksu and Yili. The four areas did not differ significantly with regard to thyroid nodules, autoimmune thyroiditis or goitre. However, the detection rates of subclinical hypothyroidism (16·6 %) and total thyroid dysfunction (25·4 %) were higher among women in Yili. The supplementation with Lipiodol capsules had improved the iodine nutrition status of women in iodine-deficient areas of Xinjiang since 2006. To avoid negative effects of excess iodine, we suggest a gradual discontinuation of Lipiodol capsules in women with special needs based on the existing iodine nutrition level of local women.
Supported by (1) medical research grants CMRPG3C0041/42 from Chang Gung Memorial Hospital and NRRPG2H0031 from Ministry of Science and Technology, Taiwan to Chemin Lin (2) NMRPG3G6031/32 from Ministry of Science and Technology, Taiwan to Shwu-Hua, Lee (3) the KKHo International Charitable Foundation to Tatia Lee.
Suicide rate tends to peak in old age, and major depression is the most salient risk factor for late-life suicide. However, few studies have focused on the neuroscientific facet of suicide in the context of late-life depression (LLD).
We recruited 114 participants of LLD (28 with history of suicide attempt and 86 without) and 47 elderly controls. They received MRI scanning and behavioral assessment. White matter hyperintensity (WMH) was quantified by an automated segmentation algorithm and graph theoretical analysis was applied to resting-state fMRI. We used ANCOVA to compare group difference in WMH loading and multivariate generalized linear model to compare global and local topological parameters in fMRI signals, controlling for demographics. Partial correlation was conducted between imaging parameters and behavioral data in group of suicide attempters.
We found significant higher WMH in suicide attempters than those of LLD without suicide attempts and elderly controls (F =7.091; p = 0.001). Suicide attempters also had increased betweenness centrality (BC) in right superior occipital gyrus (SOG) (Bonferroni corrected), right precuneus (False positive corrected) and right superior temporal gyrus (uncorrected) and decreased BC in left hippocampus (uncorrected). In suicide attempters, higher BC in right SOG correlated with higher WMH, higher depression severity, higher illness awareness and insight, and lower cognitive function (digit backward), while higher BC in right precuneus correlated with higher decrease awareness and insight and higher cognitive function (digit backward).
Resonating with the vascular hypothesis in LLD, higher WMH was found in those having history of suicide attempts. However, the re-organized brain topology changes are related with divergent cognitive function and convergent heightened disease insight.
The earliest colonisation of oceanic islands by Homo sapiens occurred ~50 000–30 000 years ago in the Western Pacific, yet how this was achieved remains a matter of debate. With a focus on East Asia, the research presented here tests the hypothesis that bamboo rafts were used for these early maritime migrations. The authors review the evidence for Palaeolithic seafaring in East Asia as the context for an experimental archaeology project to build two bamboo watercraft. Sea trials demonstrate the unsuitability of bamboo, at least in East Asia, indicating that more sophisticated and durable vessels would have been required to traverse the Kuroshio Current.
Perceived loneliness, an increasingly prevalent social issue, is closely associated with major depressive disorder (MDD). However, the neural mechanisms previously implicated in key cognitive and affective processes in loneliness and MDD still remain unclear. Such understanding is critical for delineating the psychobiological basis of the relationship between loneliness and MDD.
We isolated the unique and interactive cognitive and neural substrates of loneliness and MDD among 27 MDD patients (mean age = 51.85 years, 20 females), and 25 matched healthy controls (HCs; mean age = 48.72 years, 19 females). We assessed participants' behavioral performance and neural regional and network functions on a Stroop color-word task, and their resting-state neural connectivity.
Behaviorally, we found greater incongruence-related accuracy cost in MDD patients, but reduced incongruence effect on reaction time in lonelier individuals. When performing the Stroop task, loneliness positively predicted prefrontal-anterior cingulate-parietal connectivity across all participants, whereas MDD patients showed a decrease in connectivity compared to controls. Furthermore, loneliness negatively predicted parietal and cerebellar activities in MDD patients, but positively predicted the same activities in HCs. During resting state, MDD patients showed reduced parietal-anterior cingulate connectivity, which again positively correlated with loneliness in this group.
We speculate the distinct neurocognitive profile of loneliness might indicate increase in both bottom-up attention and top-down executive control functions. However, the upregulated cognitive control processes in lonely individuals may eventually become exhausted, which may in turn predispose to MDD onset.
To explore whether and how group cognitive-behavioural therapy (GCBT) plus medication differs from medication alone for the treatment of generalised anxiety disorder (GAD).
Hundred and seventy patients were randomly assigned to the GCBT plus duloxetine (n=89) or duloxetine group (n=81). The primary outcomes were Hamilton Anxiety Scale (HAMA) response and remission rates. The explorative secondary measures included score reductions from baseline in the HAMA total, psychic, and somatic anxiety subscales (HAMA-PA, HAMA-SA), the Hamilton Depression Scale, the Severity Subscale of Clinical Global Impression Scale, Global Assessment of Functioning, and the 12-item Short-Form Health Survey. Assessments were conducted at baseline, 4-week, 8-week, and 3-month follow-up.
At 4 weeks, HAMA response (GCBT group 57.0% vs. control group 24.4%, p=0.000, Cohen’s d=0.90) and remission rates (GCBT group 21.5% vs. control group 6.2%, p=0.004; d=0.51), and most secondary outcomes (all p<0.05, d=0.36−0.77) showed that the combined therapy was superior. At 8 weeks, all the primary and secondary significant differences found at 4 weeks were maintained with smaller effect sizes (p<0.05, d=0.32−0.48). At 3-month follow-up, the combined therapy was only significantly superior in the HAMA total (p<0.045, d=0.43) and HAMA-PA score reductions (p<0.001, d=0.77). Logistic regression showed superiority of the combined therapy for HAMA response rates [odds ratio (OR)=2.12, 95% confidence interval (CI) 1.02−4.42, p=0.04] and remission rates (OR=2.80, 95% CI 1.27−6.16, p=0.01).
Compared with duloxetine alone, GCBT plus duloxetine showed significant treatment response for GAD over a shorter period of time, particularly for psychic anxiety symptoms, which may suggest that GCBT was effective in changing cognitive style.
We aimed to investigate the association between plasma retinol and incident cancer among Chinese hypertensive adults. We conducted a nested case–control study, including 231 patients with incident cancer and 231 matched controls during a median 4·5-year follow-up of the China Stroke Primary Prevention Trial. There was a significant, inverse association between retinol levels and digestive system cancer (per 10 μg/dl increases: OR 0·79; 95 % CI 0·69, 0·91). When compared with participants in the first quartile of retinol (< 52·3 μg/dl), a significantly lower cancer risk was found in participants in quartile 2–4 ( ≥ 52·3 μg/dl: OR 0·31; 95 % CI 0·13, 0·71). However, there was a U-shaped association between retinol levels and non-digestive system cancers where the risk of cancers decreased (although not significantly) with each increment of plasma retinol (per 10 μg/dl increases: OR 0·89; 95 % CI 0·60, 1·31) in participants with retinol < 68·2 μg/dl, and then increased significantly with retinol (per 10 μg/dl increase: OR 1·65; 95 % CI 1·12, 2·44) in participants with retinol ≥ 68·2 μg/dl. In conclusion, there was a significant inverse dose–response association between plasma retinol and the risk of digestive system cancers. However, a U-shaped association was observed between plasma retinol and the risk of non-digestive cancers (with a turning point approximately 68·2 μg/dl).
Indicators are used as a benchmark for the quality of disaster response. Desirable attributes of indicators include precision, clear definition, improvement opportunity, unbiased, flexibility, and validity. Due to a lack of universally acceptable, objective indicators, it is currently difficult to gauge improvements in mass casualty preparedness within a hospital.
To describe existing indicators relevant to hospital disaster response, and to explore the use of two new indicators (decanting and chain of command).
A structured literature search in indexed databases was used to identify articles related to the measurement of hospital performance in mass casualties using a matrix technique and snowballing. Relevant websites of disaster management organizations were also reviewed and local disaster management experts were interviewed. Proposed indicators were compared against attributes and some (triage time by category, notification time, time to adequate staff response, preventable deaths, decanting times and chain of command for intensive care unit, and emergency department) were tested and measured in two exercises involving more than 90 staff each, held at two Southeast Queensland hospitals in 2017 and 2018.
Over 50 proposed indicators, including indicators within large sets, were identified. Measurement of some indicators was found to be highly subjective. The decanting and chain-of-command indicators emerged as most useful. Intensive Care Unit required 40 mins to decant beds by 50%, while ED required 25 mins to decant beds by 80%. With regards to the chain of command, ED and triage staff performed best, with 66.7% correctly identifying their immediate supervisor. Overall, staff members were able to correctly identify immediate supervisor better compared to team leaders (59.3% and 40% respectively).
There is a need to narrow down, simplify, and objectify indicators for mass casualty performance. Baseline measurements from actual disasters will provide important comparative data.
World events continue to compel hospitals to have agile and scalable response arrangements for managing natural and instigated disasters. While many hospitals have disaster plans, few exercise these plans or test their staff under realistic scenarios.
This study explores changes in perceived preparedness of multidisciplinary hospital-wide teams to manage mass casualty incidents.
Two Emergo Train System (ETS) mass casualty exercises involving 80 and 86 “victims,” respectively, were run at two southeast Queensland hospitals: one large teaching hospital and one smaller regional hospital. Pre- and post-exercise surveys were administered, capturing participants’ confidence, skills, and process knowledge anonymously on 5-point Likert scales. A waiver of ethics review was obtained. Changes in individuals’ pre- and post-scores were analyzed using paired t-tests. Open-ended questions and a “hot debrief” occurring immediately post-exercise allowed for capture of improvement ideas.
Nearly 200 unique healthcare staff (n=193) participated in one exercise. At least one survey was returned by 159 staff (82.4%). Pre- and post- surveys were available for 89 staff; two-thirds (n=59) were nurses or doctors, and 46% overall were emergency department clinicians. Ninety-seven percent reported the exercise was valuable, also recommending additional simulations. Analysis of the 89 matched-pairs showed significant (p<.001) increases in self-confidence, skills, and knowledge (point increases on a five-point Likert scale (95% confidence intervals): 0.8 (0.6-0.9) for confidence and 0.4 (0.2-0.5) for both skills and knowledge. The exercise was critically appraised and a summary of operational learnings was developed. The most common criticism of ETS was its lack of real patients.
Involvement in simulated exercises (e.g. ETS) can increase confidence, knowledge, and skills of staff to manage disasters, with the biggest improvement in confidence. Whilst validating and testing plans, simulations can also uncover opportunities to improve processes and systems.
There is limited experience about transcatheter closure of doubly committed subarterial ventricular septal defects with Amplatzer ductal occluder.
Between March, 2015 and July, 2017, a total of 22 patients with doubly committed subarterial ventricular septal defects received transcatheter closure using Amplatzer ductal occluder and underwent clinical follow-up for at least 6 months.
Device implantation was finally successful in 21 (95.4%) patients despite failed occlusion in one patient and intra-procedural replacement of unsuitable occluders in four (19.0%) patients. In mean 12.3 months of follow-up, there were no major complications (death, aortic valve or sinus rupture, device dislocation or embolisation, grade 2 new-onset aortic regurgitation, etc.), resulting in clinical occlusion success of 95.4%. Mechanical haemolysis occurred in one patient and resolved with medication. Residual shunt was observed in 11 (52.4%) patients (9 mild, 2 moderate-severe) post-procedurally, 14 (66.7%) patients (12 mild, 2 moderate-severe) in hospital stay, and 2 (9.5%) patients (2 mild, 0 moderate-severe) at the last follow-up. Device-induced new-onset aortic regurgitation was found in nine (42.8%) patients (9 mild, 0 moderate-severe) post-procedurally and in hospital stay, which was resolved in two (9.5%) patients and unchanged in seven (33.3%) patients at the last follow-up. Another four (19.0%) patients newly developed mild aortic regurgitation during follow-up.
Transcatheter closure of doubly committed subarterial ventricular septal defects with Amplatzer ductal occluder is technically feasible in the selected patients. However, further study is needed to confirm its long-term clinical outcomes.
In 2007, Taiwan began conducting health technology assessments (HTA) to support the National Health Insurance Administration (NHIA) in its reimbursement decisions for drugs, medical devices, and medical services.
In this study, the development, missions, and procedures of the implementation of HTA in Taiwan are briefly introduced. Moreover, the value of HTA is examined by reviewing the outcomes and impacts of recent HTA-related research projects, which are classified into five categories: (i) pharmaceutical products, (ii) medical procedures, (iii) medical devices, (iv) health policy, and (v) social care.
Overall, the 10-year implementation of HTA has not only supported the government's decision making but also enhanced patient care. Furthermore, patient evidence has been highlighted, and patient care pathways have been transformed through patient involvement in HTA.
In conclusion, HTA's value has been determined by both government and social aspects in Taiwan.
Staminodes are sterile stamens that produce no pollen, exhibit diverse structures and perform various functions. Flowers of Phanera yunnanensis possess three fertile stamens with large anthers and long filaments, and seven staminodes with tiny anthers and short filaments. To investigate the adaptive significance of staminodes in this species, we studied effects of staminode removal on pollen removal and deposition, flower visitation rate and fruit set in Xishuangbanna, south-western China. Four species of nectar-foraging pollinators visited flowers, mostly Amegilla zonata and Apis cerana (2.80 ± 0.15 and 1.76 ± 0.41 visits h−1 per flower, respectively). Staminode removal did not affect fruit set, but increased visitation by A. cerana by 2.6-fold, reduced visitation by A. zonata by 68% and increased the pollen removal rate for both pollinators (all effects were significant). Staminode removal significantly reduced pollen deposition rate for A. zonata, but not for A. cerana. These results suggest that the staminodes of P. yunnanensis filter which insects act as pollinators and affect pollen removal and deposition rates. By reducing pollen removal rates, staminodes may implement a pollen-dispensing schedule that spreads pollen dispersal from individual flowers over multiple pollinators. By altering pollen deposition rates, staminodes may influence reproductive fitness in other ways.
Assembly optimization of printed circuit boards (PCBs) has received considerable research attention because of efforts to improve productivity. Researchers have simplified complexities associated with PCB assembly; however, they have overlooked hardware constraints, such as pick-and-place restrictions and simultaneous pickup restrictions. In this study, a hybrid group search optimizer (HGSO) was proposed. Assembly optimization of PCBs for a multihead placement machine is segmented into three problems: the (1) auto nozzle changer (ANC) assembly problem, (2) nozzle setup problem, and (3) component pick-and-place sequence problem. The proposed HGSO proportionally applies a modified group search optimizer (MGSO), random-key integer programming, and assigned number of nozzles to an ANC to solve the component picking problem and minimize the number of nozzle changes, and the place order is treated as a traveling salesman problem. Nearest neighbor search is used to generate an initial place order, which is then improved using a 2-opt method, where chaos local search and a population manager improve efficiency and population diversity to minimize total assembly time. To evaluate the performance of the proposed HGSO, real-time PCB data from a plant were examined and compared with data obtained by an onsite engineer and from other related studies. The results revealed that the proposed HGSO has the lowest total assembly time, and it can be widely employed in general multihead placement machines.
Propofol is a intravenous anaesthetic most commonly used in ultrasound oocyte retrieval. We studied if the use of propofol had an effect on mouse oocyte maturation, pregnancy, childbirth and progeny and investigated the correlation between propofol side effects and reproductive performance in mice. There was no statistical difference in mating, pregnancy, childbirth, litter size, the number of stillbirths and survival between each group (P>0.05). Propofol also had no effect on polar body extrusion in oocyte maturation as well as on pronucleus formation and, subsequently, early embryo development (P>0.05). An increased concentration of propofol had no effect on this result, although propofol at more than 0.01 mg/ml reduced polar body extrusion. Different concentrations of propofol had no effect on oocyte culture in vitro, pronucleus formation and early embryo development.
Mastery of strengthening strategies to achieve high-capacity anodes for lithium-ion batteries can shed light on understanding the nature of diffusion-induced stress and offer an approach to use submicro-sized materials with an ultrahigh capacity for large-scale batteries. Here, we report solute strengthening in a series of silicon (Si)–germanium (Ge) alloys. When the larger solute atom (Ge) is added to the solvent atoms (Si), a compressive stress is generated in the vicinity of Ge atoms. This local stress field interacts with resident dislocations and subsequently impedes their motion to increase the yield stress in the alloys. The addition of Ge into Si substantially improves the capacity retention, particularly in Si0.50Ge0.50, aligning with literature reports that the Si/Ge alloy showed a maximum yield stress in Si0.50Ge0.50. In situ X-ray diffraction studies on the Si0.50Ge0.50 electrode show that the phase change undergoes three subsequent steps during the lithiation process: removal of surface oxide layer, formation of cluster-size Lix(Si,Ge), and formation of crystalline Li15(Si,Ge)4. Furthermore, the lithiation process starts from higher index facets, i.e., (220) and (311), then through the low index facet (111), suggesting the orientation-dependence of the lithiation process in the Si0.50Ge0.50 electrode.
Apathy is a condition characterized by a lack of motivation that manifests in emotional, behavioral, and cognitive domains. Although previous studies have indicated that apathy is associated with frontal lesions, few studies have focused on the different subdomains of apathy, and no in vivo human biochemical data have been obtained to examine the neurochemical changes related to apathy in patients with Alzheimer's disease (AD). Thus, we investigated the frontal neurochemical alterations related to apathy among patients with AD using proton magnetic resonance spectroscopy (1H MRS).
Apathy was assessed through the Apathy Evaluation Scale (AES). 1H MRS was performed to measure neurochemical metabolite levels in the anterior cingulate region and right orbitofrontal region. Associations between neurochemical metabolites and the total score and subscores of each domain of the AES were analyzed.
Altogether, 36 patients completed the study. Patients with lower N-acetylaspartate/creatine ratios (NAA/Cr) in the anterior cingulate region demonstrated higher total apathy scores (β = −0.56, p = 0.003) with adjustments for age, gender, educational level, dementia severity, and depression severity. In a further analysis, a lower NAA/Cr in the anterior cingulate region was associated with all subdomains of apathy, including cognition (β = −0.43, p = 0.028), behavior (β = −0.55, p = 0.002), and emotion (β = −0.50, p = 0.005). No statistically significant associations were discovered in the right orbitofrontal region.
Our results suggest that apathy, in each of its cognitive, behavioral, or emotional subdomains is associated with brain neurochemical alterations in the anterior cingulate region. Abnormal neuronal integrity over the anterior cingulate cortex may exhibit a central role in causing all aspects of apathy in patients with AD.
To examine and quantify the potential dose–response relationship between green tea intake and the risk of gastric cancer.
We searched PubMed, EMBASE, Web of Science, CBM, CNKI and VIP up to December 2015 without language restrictions.
A systematic review and dose–response meta-analysis of observational studies.
Five cohort studies and eight case–control studies.
Compared with the lowest level of green tea intake, the pooled relative risk (95 % CI) of gastric cancer was 1·05 (0·90, 1·21, I2=20·3 %) for the cohort studies and the pooled OR (95 % CI) was 0·84 (0·74, 0·95, I2=48·3 %) for the case–control studies. The pooled relative risk of gastric cancer was 0·79 (0·63, 0·97, I2=63·8 %) for intake of 6 cups green tea/d, 0·59 (0·42, 0·82, I2=1·0 %) for 25 years of green tea intake and 7·60 (1·67, 34·60, I2=86·5 %) for drinking very hot green tea.
Drinking green tea has a certain preventive effect on reducing the risk of gastric cancer, particularly for long-term and high-dose consumption. Drinking too high-temperature green tea may increase the risk of gastric cancer, but it is still unclear whether high-temperature green tea is a risk factor for gastric cancer. Further studies should be performed to obtain more detailed results, including other gastric cancer risk factors such as smoking and alcohol consumption and the dose of the effective components in green tea, to provide more reliable evidence-based medical references for the relationship between green tea and gastric cancer.
To develop a theoretical model explaining the longitudinal changes in the caregiving process for family caregivers of persons with mild cognitive impairment (MCI) in Taiwan.
A longitudinal, grounded theory approach using in-depth face-to-face interviews and an open-ended interview guide. We conducted 42 interviews over a two-year period; each participant was interviewed at least once every six months. All participants were interviewed in their home. The participants total of 13 family caregivers of persons with MCI.
One core theme emerged: “protective preparation.” This reflected the family caregiving process of preparation for a further decline in cognitive function, and protection from the impact of low self-esteem, accidents, and symptoms of comorbidities for the family member with MCI. Protective preparation contained three components: ambivalent normalization, vigilant preparation, and protective management.
Interventions to help family caregivers manage the changes in persons with MCI can reduce caregiver burden. Our findings could provide a knowledge base for use by healthcare providers to develop and implement strategies to reduce caregiver burden for family caregivers of persons with MCI.
Kawasaki disease, which is characterised by systemic vasculitides accompanied by acute fever, is regularly treated by intravenous immunoglobulin to avoid lesion formation in the coronary artery; however, the mechanism of intravenous immunoglobulin therapy is unclear. Hence, we aimed to analyse the global expression profile of serum exosomal proteins before and after administering intravenous immunoglobulin.
Two-dimensional electrophoresis coupled with mass spectrometry analysis was used to identify the differentially expressed proteome of serum exosomes in patients with Kawasaki disease before and after intravenous immunoglobulin therapy.
Our analysis revealed 69 differential protein spots in the Kawasaki disease group with changes larger than 1.5-fold and 59 differential ones in patients after intravenous immunoglobulin therapy compared with the control group. Gene ontology analysis revealed that the acute-phase response disappeared, the functions of the complement system and innate immune response were enhanced, and the antibacterial humoral response pathway of corticosteroids and cardioprotection emerged after administration of intravenous immunoglobulin. Further, we showed that complement C3 and apolipoprotein A-IV levels increased before and decreased after intravenous immunoglobulin therapy and that the insulin-like growth factor-binding protein complex acid labile subunit displayed reverse alteration before and after intravenous immunoglobulin therapy. These observations might be potential indicators of intravenous immunoglobulin function.
Our results show the differential proteomic profile of serum exosomes of patients with Kawasaki disease before and after intravenous immunoglobulin therapy, such as complement C3, apolipoprotein A-IV, and insulin-like growth factor-binding protein complex acid labile subunit. These results may be useful in the identification of markers for monitoring intravenous immunoglobulin therapy in patients with Kawasaki disease.
In Taiwan the discussion of civil society emerged in the 1980s and peaked in the early 1990s, when the society underwent political democratization. Civil society was considered a public sphere, enjoying relatively autonomy from the control of the state or the market. The birth of civil society in Taiwan came about by the proliferation of non-profit organizations, community organizations, and professional and voluntary groups through continuous social mobilization. Lawmaking was indispensable for the consolidation of civil society. New ordinances, ranging from human rights, environmental regulation to cultural preservation, were brought to the agenda. The emergence of civil society allowed people to leverage themselves from the control of the state and the market. In addition to this, the new Taiwanese identity that took shape in the 1990s reinforced the civil society that was in the making. However, across the turn of the millennium, as the state– society relationship reconfigured, civil society also differentiated. Both the market and the state tried to entrench civil society, which more often than not led to many different voices within civil society. Conflicts among various social groups have become a noticeable feature in the debates and decision-making processes of public affairs.
Against this backdrop we would like to trace the early history of the development of the idea of heritage preservation in Taiwan. The emergence of the heritage preservation movement and related policies is closely intertwined with the changing cultural politics that reflect the contested meanings of national and local identities in Taiwan. Before the lifting of martial law in 1987, civil society had played a significant role in heritagemaking. Since 1987, civil society has further pushed the state to change the laws and policies governing heritage preservation.
The first piece of legislation in this area, the Cultural Heritage Preservation Act, was promulgated in Taiwan in 1982, while the country was still under authoritarian rule. The implementation of the Heritage Act and associated cultural policies inevitably reflected the Chinese nationalist historical narrative; however, at the same time, it created negotiable spaces for diverse narratives through the imported notion of “cultural heritage”, which could be seen as an indirect challenge to the dominant narrative.