ABSTRACTInattentional blindness occurs when observers fail to detect unexpected objects or events. Despite the adaptive importance of detecting unexpected threats, relatively little research has examined how stimulus threat influences IB. The current study was designed to explore the effects of stimulus threat on IB. Past research has also demonstrated that individuals with elevated negative affectivity have an attentional bias towards threat-related stimuli; therefore, the current study also examined whether state and trait levels of negative affectivity predicted IB for threat-related stimuli. (...) One hundred and eleven participants completed an IB task that included both threat-related and neutral unexpected stimuli, while their eye movements were tracked. Participants were significantly more likely to detect the threatening stimulus than the neutral stimulus p =.035, odds ratio = 4.0, 95% confidence interval OR [1.13, 14.17]. Neither state nor trait... (shrink)

Bone marrow is the main site for hematopoiesis in adults. It acts as a niche for hematopoietic stem cells (HSCs) and contains non‐hematopoietic cells that contribute to stem cell dormancy, quiescence, self‐renewal, and differentiation. HSC also exist in resting spleen of several species, although their contribution to hematopoiesis under steady‐state conditions is unknown. The spleen can however undergo extramedullary hematopoiesis (EMH) triggered by physiological stress or disease. With the loss of bone marrow niches in aging and disease, the spleen as (...) an alternative tissue site for hematopoiesis is an important consideration for future therapy, particularly during HSC transplantation. In terms of harnessing the spleen as a site for hematopoiesis, here the remarkable regenerative capacity of the spleen is considered with a view to forming additional or ectopic spleen tissue through cell engraftment. Studies in mice indicate the potential for such grafts to support the influx of hematopoietic cells leading to the development of normal spleen architecture. An important goal will be the formation of functional ectopic spleen tissue as an aid to hematopoietic recovery following clinical treatments that impact bone marrow. For example, expansion or replacement of niches could be considered where myeloablation ahead of HSC transplantation compromises treatment outcomes. (shrink)

Michael A. Petersa and Fazal Rizvib aBeijing Normal University, Beijing, PR China; bMelbourne University, Melbourne, Australia Our minds are still racing back and forth, longing for a return to ‘no...

Background: Previous studies have found that alexithymia plays an important role in the pathogenesis of Internet addiction. However, the effect of alexithymia on both metacognition and Internet addiction has yet to be examined.Methods: The Toronto Alexithymia Scale, Metacognition Questionnaire, and Internet Addiction Test were used to assess a sample of 356 college students. A parallel mediator effect analysis was applied to test the hypothesis that metacognition mediates the relationship between alexithymia and Internet addiction.Results: The parallel multiple mediator models showed that (...) alexithymia predicted the five dimensions of metacognition and Internet addiction, and that three dimensions—cognitive confidence, positive beliefs about worry, and the need to control thoughts—partially mediated this relationship.Conclusion: Alexithymia could directly and indirectly predict Internet addiction via metacognition. (shrink)

Environmental ethics can be cultivated in China and other Asian countries based on Chinese philosophical perspectives. Two major Chinese philosophies relevant to the issues of environmental ethics—Confucianism and Taoism—suggest certain approaches to developing environmental ethics. These approaches can complement each other in developing a Chinese or East Asian theory of environmental ethics. Drawing on these perspectives, China’s Wolong National Nature Reserve can face the challenge of protecting its pandas while developing the local economy. By adopting a set of strategies with (...) elements from both Confucianism and Taoism, Wolong has fared well in both protecting pandas and promoting environmental ethics. This case has implications for both managerial researchers and practitioners. (shrink)

BackgroundDepression is common psychiatric morbidity in breast cancer survivors, seriously affecting patients’ quality of life and mental health. A growing body of research has investigated depression in breast cancer. However, no visual bibliometric analysis was conducted in this field. This study aimed to visualize the literature to identify hotspots and frontiers in research on breast cancer and depression.MethodsThe publications related to depression in breast cancer were retrieved in the Web of Science Core Collection between 1 January 2002 and 17 March (...) 2022. VOSviewer was used to identify co-occurrences and collaborations among countries, institutions, and keywords. CiteSpace was used to detect keyword bursts.ResultsA total of 7,350 articles and reviews related to depression in breast cancer were identified. From 2002 to 2022, the United States and the People’s Republic of China were the most productive countries in this field. The University of California, Los Angeles, and the University of Toronto were the most productive institutions in this field. The Journal of Psycho-oncology, followed by Supportive Care in Cancer and the Journal of Clinical Oncology, had the most publications on depression in breast cancer. Of the top 10 journals, seven were from the United States, two were from England, and one was from Germany. Five research hotspots of depression in breast cancer were identified by co-word analysis. Research on post-traumatic growth, spiritual interventions, cognitive-behavioral therapy, physical activity, and symptom cluster management of depression in breast cancer was relatively mature in the core hotspots. Burst detection of keywords on depression in breast cancer showed the latest hotspots, such as mental health, cancer survivor mortality, and activity.ConclusionThe research on depression in breast cancer is growing. Attention should be paid to the latest hotspots, such as mental health, cancer survivor, mortality, exercise, and physical activity. (shrink)

With the increasing mobility of the rural population in China and the growing number of residents moving to the cities for work or study, rural society is forming a pluralistic, interest-centered, “open” social networks relations that follows the modern rule of law contract. Based on Chinese General Social Survey data, the results of the empirical study finds that social insurance can significantly enhance the social interactions of rural residents in China, that is, formal social security system in rural areas promotes (...) informal social security mechanisms such as social interactions. The results of the grouping test show that rural residents in China’s different regions were affected by social insurance in different ways. Social insurance has a greater impact on the social interactions in the eastern region than in the middle and western regions. The propensity score matching method was used to reduce the sample selection bias, and the findings of the paper were found to be robust. (shrink)

Despite various studies examining intertemporal choice with hypothetical rewards due to problematic real reward delivery, there remains no substantial evidence on the effect of the incentives on the decision confidence and cognitive process in intertemporal choice and no comprehensive exploration on the loss domain. Hence, this study conducts an eye-tracking experiment to examine the effect of incentive approach and measure participants' decision confidence using a between-subject design in both gain and loss domains. Results replicated previous findings which show incentives do (...) not affect intertemporal choice in the gain domain. In contrast, in the loss domain, participants in the incentivized group were more likely to choose the larger-later options than those in the non-incentivized group. Furthermore, the decision confidence and the mean fixation duration differed between the incentivized and non-incentivized groups in both gain and loss domains. These findings allow for a better understanding of the effect of incentives on intertemporal choice and provide valuable information for the design of incentives in future intertemporal experiments. (shrink)

Liver transplantation (LT) activities during the COVID-19 pandemic have been curtailed in many countries. The impact of various policies restricting LT on outcomes of potential LT candidates is unclear. We studied all patients on the nationwide LT waitlists in Hong Kong and Singapore between January 2016 and May 2020. We used continuous time Markov chains to model the effects of different scenarios and varying durations of disruption on LT candidates.

Although not frequently regarded as controversial, digital communications industries continue to be sites of CSR conflicts, particularly internationally. Investigating CSR issues in the digital communications industry is pertinent because in addition to being one of the fastest growing industries, it has created a host of new CSR issues that require further attention. This case study examines an incident in early 2010, when Google Inc. China and the Chinese government reached an impasse that produced a large-scale, transnational conflict that reached a (...) head ostensibly over state-mandated censorship, ultimately prompting Google to withdraw from the mainland Chinese market and redirect its activities to Hong Kong. We track Google's experience in China, both to explore its strategies and to consider the implications for corporate social responsibility. We situate Google's drastic decision to withdraw entirely from mainland China in the complex multiplicity of ethical, cultural, and political conflicts that affect this particular case. On a broader level, the incident raises the question of how multinational corporations (MNCs) can achieve corporate growth while negotiating the highly sensitive sociopolitical and institutional environments of foreign nations. (shrink)

This study addresses two issues. First, does corporate social performance matter in Hong Kong. Second, if yes, is it relevant to some industries more than others. To answer these questions, we develop a corporate social performance index (CSP) to measure the quality of corporate social performance of major Hong Kong listed firms. The criteria are based on the OECD Principles of Corporate Governance. Using the 3-year period from 2002 to 2005, we find that firm valuation is positive and (...) significantly associated with CSP. Interestingly, this relation matters less in China related firms and firms with a concentrated ownership structure. The results also show that CSP impacts firm valuation more positively when the firm is in the service sector. We further find that CSP is positively related to the market valuation of the subsequent year. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Philosophical Enactment and Bodily Cultivation in Early Daoism: In the Matrix of the Daodejing by Thomas MichaelJing Tan (bio) and Xiangfei Bao (bio)Philosophical Enactment and Bodily Cultivation in Early Daoism: In the Matrix of the Daodejing. By Thomas Michael. London: Bloomsbury Academic, 2022. Pp. x + 278. Hardcover $115.00, isbn 978-1-3502-3665-3. Thomas Michael's Philosophical Enactment and Bodily Cultivation in Early Daoism: In the Matrix of the Daodejing (hereafter (...) Philosophical Enactment) brings forward new perspectives and pathways to one of the most important topics concerning the reconstruction of early Daoist history. The author has contributed two other original and insightful monographs to the study of Daoism, including In the Shadows of the Dao: Laozi, the Sage, and the Daodejing (Albany, NY: State University of New York Press, 2015) and The Pristine Dao: Metaphysics in Early Daoist Discourse (Albany, NY: State University of New York Press, 2005). Together with his newly published research article "The Original Text of the Daodejing: Disentangling Versions and Recensions" (Religions 13, No. 4, (2022): 325), Michael has displayed his erudition and expertise in the study of early Chinese religion and philosophy in both a sinological and philosophical way. His Philosophical Enactment sheds new light on the history of early Daoism. Writing the history of early Daoism is not easy, as Daoism is not ready-made and has no clear boundaries. The difficulty lies not only in its entanglement with, for instance, Confucianism and Legalism, but also in when Daoism began and how it transformed. Narrating the origin and the vicissitude of Daoism requires a prescribed narrative logic or a choice of philosophical paradigm. Piling up materials is not history writing. A typical pattern in writing the history of early Daoism is distinguishing the Daoist school of philosophy (daojia 道家) from Daoist religion (daojiao 道教).1 Indeed, this distinction brings much convenience to the history writing of Daoism and has been adopted by many scholars. Though some do not explicitly state this distinction, the structure of their writings indicates it.2 The distinction between daojia and daojiao was recognized by scholars long before Fung Yu-Lan 馮友蘭 (1895-1900) published his A Brief History of Chinese Philosophy in 1948. [End Page 1] Xu Dishan 許地山 (1893-1941) believes that such a distinction can be traced back to the "Three Ranks" (sanpin shuo三品說) in Liu Xie's 劉勰 (ca. 465-532) "On Eliminating Doubts" (Miehuo lun滅惑論).3However, the received distinction between daojia and daojiao is a retrospective one. It is the product of modern discipline classification and is based on the modern understanding of philosophy and religion. Such a distinction must have been unknown to the people before and during the Han. This distinction may also cause difficulties, for instance, how to classify Ge Hong 葛洪 (283-343) and his works. Wang Ka 王卡 (1956-2017) categorized Ge Hong as a Daoist philosopher,4 while Tang Yijie 湯一介 (1927-2014) assigns Ge Hong to Daoist religion. Tang even asserts that Ge Hong established a theoretical system for Daoist religion. 5 The practice of distinguishing and dichotomizing the Daoist school of philosophy and Daoist religion has been opposed by many researchers. The French Sinologist Henri Maspéro (1883-1945) argues that daojia and daojiao are not so distinct as is often received; they both belong to the same ancient tradition. Maspéro's opposition to the dichotomy was also supported by Joseph Needham (1900-1995), Kristof Schipper (1934-2021), and others.6Although many scholars find it difficult to sharply separate the Daoist school of philosophy from Daoist religion,7 and also find it improper to dichotomize these two concepts, they still commonly accept the distinction and then trying to bridge the two. However, the dilemma faced by scholars compels us to wonder about the appropriateness of the philosophical paradigm dictating this distinction. In other words, do we have a more appropriate alternative? Thomas Michael's Philosophical Enactment provides us with a new perspective for reconsidering the problem of the relationship between the Daoist school of philosophy and Daoist religion, while also being an excellent example of the history writing of early Daoism. According to the general view, the Daodejing belongs to Daoist philosophy because it offers systematic... (shrink)

《三枣红楼谈国学》收录了周桂钿先生多年来在《哲学动态》《周易研究》《中国哲学史》《人民日报》《光明日报》等刊物发表的论文，本次集结成册，选取原则是作者对学界定论的突破，在中国哲学研究中的新观点、新思想 。按照主题，分为旧说新论、人物品评、哲思考辨、德育述评、忆往察今等部分。.

Tales from Tang Dynasty China: Selections from the Taiping Guangji. Edited by Alexei Kamran Ditter; Jessey Choo; and Sarah M. Allen. Indianapolis: Hackett Publishing Co., 2017. Pp. xiv + 162. $46 ; $16. Record of the Listener: Selected Stories from Hong Mai’s Yijian zhi. Translated by Cong Ellen Zhang. Indianapolis: Hackett Publishing Co., 2018. Pp. xliv + 116. $48 ; $16.

The importance of personal connections and relationships, or guanxi when doing business with the Chinese is widely acknowledged amongst Western academics and business managers alike. However, aspects of guanxi-rehted behaviours in the workplace are often misunderstood by Westerners with some going so far as to equate guanxi with forms of corruption. This study extends earlier study of Tan and Snell: 2002, Journal of Business Ethics 41 (December), 361-384) in its investigation of the underlying modes of moral reasoning in ethical decisions (...) relating to aspects of guanxi, amongst Hong Kong managers. Managers' ethical judgements and underlying moral reasoning relating to a series of guanxi related behaviours were recorded. Content analysis yielded categories that correspond with categories of moral reasoning described in Kohlberg's (1969, Handbook of Socialization Theory and Research, Rand McNally, Chicago, pp. 347-480) model. As hypothesised, it was found that harsher ethical evaluations of guanxi-vehted behaviours were positively correlated with the stage of moral reasoning. The most common types of reasoning were those corresponding to Kohlberg's stages four and five which relate to moral reasoning based on law and order, and on reason rather than emotion. Stage 6, concerned with more universalistic approaches to moral reasoning, was utilised considerably less, consistent with popularly held beliefs of the relativistic nature of Chinese ethics. (shrink)

This paper compares criticisms of Singapore’s meritocracy, especially against its impact on income disparities and class divisions, with Michael Sandel’s critique of the meritocratic ethic in the United States. Despite significant differences in their history and politics, meritocracy has similar dysfunctions in both societies, allowing us to draw theoretical conclusions about meritocracy as an ideal of governance. It then contrasts Sandel’s communitarian critique of meritocracy with recent Confucian promotion of political meritocracy and meritocratic justice and argues that the Confucian principle (...) of “promoting the virtuous and talented” is different from the contemporary conception of meritocracy. Textual evidence indicates that a Confucian understanding of “merit” is contrary to the technocratic expertise of contemporary meritocracies. Furthermore, pre-Qin Confucian texts do not support a conception of justice that emphasizes individual desert; they address distributive problems from the perspective of needs and sustaining social relations. The texts also support limiting the reign of merit when it results in inequalities that cause suffering, inhibit personal cultivation of some groups, or undermine social relations. The paper concludes with an assessment of Singapore’s on-going attempts to improve its meritocracy from a Confucian perspective. (shrink)

Ben shu yi Ming ru Li Cai de jiang xue huo dong yu xue pai jian gou wei zhong xin, tan tao cong shi liu shi ji chu dao shi qi shi ji mo li xue qun ti zhong xin xing xue shuo he xue pai de chan sheng, chuan bo, kuo zhan yu chuan cheng de mo shi, bing zhuo zhong cong si xiang shi de jiao du jie shi zhe zhong mo shi chan sheng he yun xing de (...) si xiang gen yuan yu nei zai dong li. Quan shu zheng wen gong qi zhang, zhu yao nei rong fen wei shang xia liang bian, shang bian yi hong guan zong lun de fang shi, cong li xue jing dian "Da xue" de wen ben bian dong he quan shi jing zheng qie ru, tan tao zhong wan Ming li xue xue shuo he xue pai jian gou de li lun gen ju; xia bian yi Li Cai de "zhi xiu" xue shuo ji qi jiang xue huo dong zuo wei ge an yan jiu, tan tao li xue xue shuo he xue pai de chuan bo ji chuan cheng de she hui hua tu jing. (shrink)

This article engages the views of PRC Confucian scholars who responded to the United States Supreme Court Justice Anthony Kennedy's citing of Confucius in his majority opinion on same-sex marriage in 2015. It questions their separation of tolerance for homosexuality from legalization of same-sex marriage and argue that tolerance is not enough. The arguments in the mainland Confucian discourse about same-sex marriage highlights the historical and persistent entanglement of Confucianism with patriarchy. Instead of reviving traditional patriarchal society, further entrenching and (...) increasing gender inequality, contemporary Confucianism could shape its own unique modern society that aspires to (and hopefully one day achieving) gender equality together with sexual inclusivity by deconstructing the patriarchal Confucian family and reconstructing a different Confucian family ideal. Accepting same-sex marriage would lend weight to the latter, and there are Confucian reasons for legalizing same-sex marriage and recognizing its ethical value. (shrink)

Duggins et al. use a spiking neural network model of working memory to predict the reaction to two drugs known to affect working memory (guanfacine and phenylephrine). The model can explain data from moneys at the biophysical, neural, and behavioral levels.

Despite flourishing as a multidisciplinary subject, the predominant view in bioethics today is based on Anglo-American thought. This has serious implications for a global bioethics that needs to be contextualized to local cultures and circumstances in order to be relevant. Being the largest continent on the earth, Asia is home to a variety of cultures, religions and countries of different economic statuses. While the practice of medicine in the East and West may be similar, its ethical practices do differ. Thus, (...) the Western understanding of autonomy may not be wholly applicable in the Asian setting, especially in the setting of breaking bad news, giving consent, determining best interests and deciding on end-of-life care. This article explores these topics in depth, attempting to find shared integrating factors, but at the same time arguing for a modified ethical application of autonomy, based on Asian beliefs. (shrink)

Inspired by Shalev’s model of loss aversion, we investigate the effect of loss aversion on a bimatrix game where the payoffs in the bimatrix game are characterized by triangular fuzzy variables. First, we define three solution concepts of credibilistic loss aversion Nash equilibria, and their existence theorems are presented. Then, three sufficient and necessary conditions are given to find the credibilistic loss aversion Nash equilibria. Moreover, the relationship among the three credibilistic loss aversion Nash equilibria is discussed in detail. Finally, (...) for2×2bimatix game with triangular fuzzy payoffs, we investigate the effect of loss aversion coefficients and confidence levels on the three credibilistic loss aversion Nash equilibria. It is found that an increase of loss aversion levels of a player leads to a decrease of his/her own payoff. We also find that the equilibrium utilities of players are decreasing as their own confidence levels when players employ the optimistic value criterion. (shrink)

Theories of aggregated legislative intent posit that the legislative intent of parliament is what a significant enough proportion of legislators intended (e.g., legislative intent is p if a majority intend that p). After all, many think the same way about democracy (‘votes reveal the will of the people’) and about courts (‘a court decision is based on judicial voting’). The existing literature on aggregated legislative intent, however, tends to make two undefended assumptions: (i) Informed Assumption: all legislators have policy intentions; (...) and (ii) Group Intent Assumption: the existence of an aggregated intent entails the existence of a group intent. Despite these assumptions being subject to great scrutiny, they largely remain undefended. This paper defends the Group Intent Assumption and shows that aggregated theories can survive with a weaker version of the Informed Assumption. (shrink)

This eighth volume of Collected Papers includes 75 papers comprising 973 pages on (theoretic and applied) neutrosophics, written between 2010-2022 by the author alone or in collaboration with the following 102 co-authors (alphabetically ordered) from 24 countries: Mohamed Abdel-Basset, Abduallah Gamal, Firoz Ahmad, Ahmad Yusuf Adhami, Ahmed B. Al-Nafee, Ali Hassan, Mumtaz Ali, Akbar Rezaei, Assia Bakali, Ayoub Bahnasse, Azeddine Elhassouny, Durga Banerjee, Romualdas Bausys, Mircea Boșcoianu, Traian Alexandru Buda, Bui Cong Cuong, Emilia Calefariu, Ahmet Çevik, Chang Su Kim, Victor (...) Christianto, Dae Wan Kim, Daud Ahmad, Arindam Dey, Partha Pratim Dey, Mamouni Dhar, H. A. Elagamy, Ahmed K. Essa, Sudipta Gayen, Bibhas C. Giri, Daniela Gîfu, Noel Batista Hernández, Hojjatollah Farahani, Huda E. Khalid, Irfan Deli, Saeid Jafari, Tèmítópé Gbóláhàn Jaíyéolá, Sripati Jha, Sudan Jha, Ilanthenral Kandasamy, W.B. Vasantha Kandasamy, Darjan Karabašević, M. Karthika, Kawther F. Alhasan, Giruta Kazakeviciute-Januskeviciene, Qaisar Khan, Kishore Kumar P K, Prem Kumar Singh, Ranjan Kumar, Maikel Leyva-Vázquez, Mahmoud Ismail, Tahir Mahmood, Hafsa Masood Malik, Mohammad Abobala, Mai Mohamed, Gunasekaran Manogaran, Seema Mehra, Kalyan Mondal, Mohamed Talea, Mullai Murugappan, Muhammad Akram, Muhammad Aslam Malik, Muhammad Khalid Mahmood, Nivetha Martin, Durga Nagarajan, Nguyen Van Dinh, Nguyen Xuan Thao, Lewis Nkenyereya, Jagan M. Obbineni, M. Parimala, S. K. Patro, Peide Liu, Pham Hong Phong, Surapati Pramanik, Gyanendra Prasad Joshi, Quek Shio Gai, R. Radha, A.A. Salama, S. Satham Hussain, Mehmet Șahin, Said Broumi, Ganeshsree Selvachandran, Selvaraj Ganesan, Shahbaz Ali, Shouzhen Zeng, Manjeet Singh, A. Stanis Arul Mary, Dragiša Stanujkić, Yusuf Șubaș, Rui-Pu Tan, Mirela Teodorescu, Selçuk Topal, Zenonas Turskis, Vakkas Uluçay, Norberto Valcárcel Izquierdo, V. Venkateswara Rao, Volkan Duran, Ying Li, Young Bae Jun, Wadei F. Al-Omeri, Jian-qiang Wang, Lihshing Leigh Wang, Edmundas Kazimieras Zavadskas. (shrink)

We use a spiking neural network model of working memory capable of performing the spatial delayed response task to investigate two drugs that affect WM: guanfacine and phenylephrine. In this model, the loss of information over time results from changes in the spiking neural activity through recurrent connections. We reproduce the standard forgetting curve and then show that this curve changes in the presence of GFC and PHE, whose application is simulated by manipulating functional, neural, and biophysical properties of the (...) model. In particular, applying GFC causes increased activity in neurons that are sensitive to the information currently being remembered, while applying PHE leads to decreased activity in these same neurons. Interestingly, these differential effects emerge from network-level interactions because GFC and PHE affect all neurons equally. We compare our model to both electrophysiological data from neurons in monkey dorsolateral prefrontal cortex and to behavioral evidence from monkeys performing the DRT. (shrink)

In general, the prayer (hacet or niyaz) windows that open to the body or courtyard wall of tombs have a majestic appearance that attracts the attention of people. The rooted visitation folklore, which encompasses praying and making requests to Allah in front of such windows, in the presence of and for the benefit of the buried person, is an important piece of religious ritual. In Istanbul folklore, Eyup Sultan Mosque and Mausoleum are places of visitation, where the public favor and (...) crowd on holy days that have religious significance. The epitaphs on these windows conclude with a call to perform a Fatiha prayer. It is understood that the prayer windows, which are located in positions that connect the hazirs with the street, were placed in order to request prayers by attracting the attention of passers-by that are visiting mosques and shrines. This study intends to determine the place of prayer windows in the discipline of Istanbul folklore and art history. The primary motivation for this study is to fill a gap in the literature by examining prayer windows, which were not present during the early stages of Islam but later developed into a sophisticated practice, especially during the Ottoman period. The first chapter of this study discusses the religious ritualistic and visitation folklore aspects of Eyup Sultan Mosque and Mausoleum. The second chapter discusses the reasons behind prayer windows being built and their importance, as well as the examination of these construction elements' morphological, material, technical, textual, decorative, and identifying constituents. Thus, as an example of an application specific to the Ottoman period in Islamic architecture and art, the prayer windows opened in the cemeteries around the Eyüp Tomb were examined, measured and drawn with AutoCAD programme within the scope of the survey, and the Muslims' view of death and the cultural heritage developed within this framework were tried to be understood. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical CommentaryChua Hong Choon, Adjunct Associate ProfessorThe case for commentary describes a difficult, and yet not uncommon, clinical situation faced by clinicians at the Institute of Mental Health (IMH) in the course of their work. Based on the information provided on the case, the patient is likely to be suffering from the paranoid subtype of schizophrenia, and his illness is characterised by hostile and aggressive behaviour during episodes (...) of relapse.Although aggressive behaviour is known to be associated with young, male patients with paranoid delusions, auditory hallucinations and lack of insight,1 it is still necessary to exclude other causes of aggressive behaviour in this young man. Two causes of aggressive behaviour that are sometimes misattributed to schizophrenia are antisocial personality disorder and substance abuse. However, Mr. T did not have a history of conduct or behavioural problems prior to the onset of his psychotic illness, and he was also not reported to be violent or disruptive during the periods when he was on regular medication. There was also no history of illicit drug use.The initial onset of Mr. T’s illness while he was serving his National Service is a fairly common presentation of the first episode of schizophrenia in Singaporean males. While traits apparent prior to National Service such as his academic difficulties and inability to make friends are associated with the development of schizophrenia,2 the stress of regimented life and military drills might be more closely associated with his initial full-blown psychotic episode with prominent paranoid (and persecutory) delusions.The systematised nature of Mr. T’s delusions and the prominent threatening auditory hallucinations significantly increase his risk of [End Page 217] dangerousness,3 and when his wife became “incorporated” into his delusional beliefs, he began to threaten her physically during episodes of relapse. Despite being only 28 years old, Mr. T has already been hospitalised numerous times for inpatient treatment, due to frequent relapses of his illness. While relapses in schizophrenia may be attributed to various factors, including lack of social support, substance abuse, poor (or partial) response to medication and psychosocial stressors, Mr. T’s multiple relapses were primarily due to the stopping of his medication and his refusal to continue with any form of psychiatric treatment.The key problem to be addressed in this case is therefore the patient’s severe lack of insight which leads to recurrent episodes of treatment non-adherence and subsequent relapses.Mr. T’s wife has come to the clinic to ask for medication to secretly put into his food. Although the patient is apparently in remission of his condition (having just been treated and discharged from hospital), he has again stopped his medication, and she is justifiably afraid that he will become unwell again. Recognising that the patient’s lack of insight is the main (and possibly only) reason for his refusal to take medication, it would be prudent to first consider if all possible actions had been taken to create an awareness and to help the patient gain insight into his illness and the need to take medication. This may yet be possible in the window of opportunity that exists when the patient is in remission of his illness (and is therefore not disturbed by the symptoms of his psychotic disorder).Recent studies have demonstrated that psycho-education is able to reduce self-stigmatisation in individuals with schizophrenia, and also significantly improve insight 4 (as measured by the Birchwood’s Psychosis Insight Scale). A 2011 Cochrane Review 5 also concluded psycho-education does seem to reduce relapse, readmission and encourage medication compliance, as well as reduce the length of hospital stays in patients with schizophrenia. In this case, psycho-education could be given to Mr. T even after he has been discharged from hospital; he might not want to continue with medication, but he might consider seeing a trained clinician (case manager, nurse or medical social worker) to make sense of his life experiences. Engaging Mr. T through psycho-education may result in sufficient insight for him to consider resuming medication voluntarily, at least in the short term.Although there is a paucity of studies examining specific psycho-therapies (including cognitive behavioural therapy... (shrink)

Resource development takes place through the transformation of social institutions. The moral dimension is of crucial importance in the evolution of associated management regimes. More than just a code of ethics, moralities are predicated on what is understood to be ‘the good’. Recognition of the good requires a rhetoric beyond those of power and interest. This paper proposes a rhetoric of love. Within this conception of morality, the management of human relationships becomes understood as an unfolding cycle of choice among (...) tragic choices and management of the non‐human environment is accomplished through the realisation of the gift relationship. (shrink)