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This study aims to explore clinicians’ practices and attitudes regarding advance care planning (ACP) in mainland China.
This study was a multicenter cross-sectional survey. Clinicians from tertiary hospitals in Beijing, Guangxi, and Inner Mongolia were invited to participate in the study. A questionnaire was formulated based on related literature to obtain information including demographic characteristics, and practices and attitudes toward ACP.
The total number of participants included 285 clinicians. The data response rate was 84.57%. Most of the clinicians had an inadequate understanding of ACP. Only a few clinicians had experience in participating or witnessing an ACP or related end-of-life discussions. Among 285 clinicians, 69.82% of clinicians were willing to introduce ACP to patients. Two hundred and thirty-eight (83.51%) clinicians wanted more education on ACP. Almost all clinicians believed that patients had the right to know about their diagnosis, prognosis, and available care options. Most clinicians (82.11%) regarded that ACP was partially feasible in mainland China. If clinicians had a serious illness, almost everyone was willing to find out their true health status and decide for themselves, and 81.40% wanted to institute an ACP for themselves. The biggest barriers to the use of ACP in mainland China were cultural factors. Statistical analysis revealed that some or good understanding level (P = 0.0052) and practical experience (P = 0.0127) of ACP were associated with the positive willingness.
Significance of results
ACP is still in its infancy in mainland China. Clinicians had inadequate understanding and minimal exposure to ACP. Most clinicians recognized the value and significance of ACP and had a positive attitude toward ACP. Clinicians need to be provided with education and training to promote their ACP practices. Culturally appropriate ACP processes and documents need to be developed based on Chinese culture and Chinese needs.
Empirical evidence suggests that close to 100 million women are “missing” worldwide. We revisit the empirical evidence for China, the country with the most missing women. Nearly ten million girls born in the 1980s and 1990s who were “missing” according to earlier census data can be found again in the 2010 population census. We discuss two possible explanations for the re-emergence of these formerly missing girls: the delayed registration of girls owing to economic reasons, and the response to amendments to the Chinese Statistics Law in 2009 and policy changes in the 2010 population census. Using the most recent statistics, we document patterns of the underreporting of women over time and across regions as well as explore the basic determinants of underreporting of women. Important policy challenges remain. For the unregistered children, the lack of access to public services will increase their vulnerability and adversely affect their quality of life.
The addition of vegetable to carbohydrate-based meals was shown to contribute to glycaemic management. The aim of this study was to investigate the impact of homogenisation on vegetables added to rice meals in terms of acute glycaemic responses (GR). In a randomised crossover trial, sixteen healthy volunteers completed thirteen test sessions, which included two sessions for glucose control, two for rice and nine for different vegetable-rice mixed meals: cooked pak choi and cooked rice (CP+R); cooked cauliflower and cooked rice (CC+R); cooked eggplant and cooked rice (CE+R); and their homogenised counterparts, both raw or cooked. Postprandial GR tests, in vitro carbohydrate digestion and chemical analyses were carried out for each test meal. Compared with pure rice, CE+R, CP+R and CC+R meals achieved significantly lower glycaemic indexes (GI) of 67, 71 and 73, whereas their homogenised counterparts failed to show significant difference with rice. The hydrolysis indexes (HI) of CE+R, CP+R and CC+R were 69·6, 83·8 and 80·6 % of the HI of the rice control. CE had the greatest effect on lowering the GI, the incremental area under the blood glucose curve from 0 to 120 min, the peak glucose value, the maximum amplitude of glucose excursion in 0–120 min (MAGE0–120), the HI and rapid available starch. Both in vitro and in vivo tests demonstrated that incorporating non-homogenised cooked vegetables into a rice meal could slow the carbohydrate digestion and improve postprandial GR. Texture properties of vegetable may play an important role in underlying glycaemic control mechanisms.
A free electron laser (FEL) amplifier with a curved
parallel plate waveguide and a planar wiggler is presented. A set of
operating equations for this FEL amplifier is derived by using the
three-dimensional nonlinear theory. The characteristics including the
evolution of power, efficiency and bandwidth of the FEL operating at the
frequency of 94 GHz are numerically analyzed. The effects of electron energy
spread and wiggler taper on saturation efficiency are also studied.
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