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Abstract Background Advance care planning (ACP) facilitates identification and documentation of patients’ treatment preferences. Its goal aligns with that of palliative care – optimizing quality of life of seriously ill patients. However, concepts of ACP and palliative care remain poorly recognized in Chinese population. This study aims at exploring barriers to ACP from perspective of seriously ill patients and their family caregivers. Methods This is a qualitative study conducted in a Palliative Day Care Centre of Hong Kong between October 2016 and July 2017. We carried out focus groups and individual interviews for the seriously ill patients and their family caregivers. A semi-structured interview guide was used to explore participants’ experiences and attitudes about ACP. Qualitative content analysis was adopted to analyze both manifest content and latent content. Results A total of 17 patients and 13 family caregivers participated in our study. The qualitative analysis identified four barriers to ACP: 1) limited patients’ participation in autonomous decision making, 2) cognitive and emotional barriers to discussion, 3) lack of readiness and awareness of early discussion, and 4) unprepared healthcare professionals and healthcare system. Conclusions Participations of seriously ill patients, family caregivers and healthcare workers in ACP initiation are lacking respectively. A series of interventions are necessary to resolve the barriers.

Adherent invasive Escherichia Coli (AIEC) has been implicated in the pathogenesis of Crohn’s disease (CD) in Western populations. Whether the presence of AIEC is also seen in CD populations of different genetic susceptibility and has negative impact on host microbiota ecology and therapeutics are unclear. AIEC presence was assessed in ileal tissues of 60 Hong Kong Chinese patients with CD and 56 healthy subjects. Mucosa microbiota was analyzed by 16s rRNA sequencing. Impact of AIEC on the gut microbiota was determined in a mouse model. AIEC was significantly more prevalent in ileal tissues of patients with CD than controls (30% vs 7.1%). Presence of AIEC in ileal tissues was associated with more severe mucosa microbiota dysbiosis in CD with decreased diversity and lower abundance of Firmicutes including butyrate producing Roseburia and probiotic Bacillus. A random forest model predicted the presence of AIEC with area under the curve of 0.89. AIEC exacerbated dysbiosis in dextran sodium sulfate (DSS)-induced colitis mice and led to resistance to restoration of normal gut microbiota by fecal microbiota transplantation (FMT). Proportion of donor-derived bacteria in AIEC-colonized mice was significantly lower than that in uninfected mice. AIEC was prevalent and associated with severe mucosa microbiota dysbiosis in CD in Hong Kong Chinese population. The presence of AIEC impeded restoration of normal gut microbiota. AIEC may serve as a keystone bacterium in CD and impact the efficacy of FMT.

Background: The reassurance provided during patient-therapist interactions is significantly associated with psychosocial outcomes, including fear and increased confidence. Currently, there are no available reviews that discuss the impact of reassurance for patients with musculoskeletal (MSK) pain. The aim of the present review was to qualitatively synthesize themes around reassurance mechanisms, and the impact during the interaction between patients with MSK pain and therapists. A systematic search strategy was undertaken. Studies were included if they were qualitative or mixed methods studies, examining the patient-therapist consultation, in any MSK clinical setting, with any health care professional, for adult patients with acute to chronic MSK pain. A thematic synthesis was conducted and supported by a particular assessment using CERQual. Results: Twenty-four studies were included (451 patients). Certain themes that related to both positive and negative outcomes of reassurance were identified as well as themes that illustrate the mechanisms causative of the outcomes. Using CerQual, we identified the most supported outcomes. Conclusions: Effective reassurance includes affectionate interactions such as therapeutic relationship building and interpersonal skills, an individualized patient-centered approach, education and the provision of self-management strategies. It should be noted that some interactions that use pathoanatomic models led patients to misinterpret the information provided, this created feelings of fear.

When the traditional "one size fits all" approach is used in designing educational games, the game context is usually arranged in a fixed sequence. However, the designated content may not effectively support the diversity of players. The player's ability and characteristics should be considered and supported with an appropriate learning context embedded in the game to facilitate personalised experiences. Adapting game scenarios to a player's characteristics can boost motivation and ultimately improve learning outcomes. This research applies a context-aware design approach and the Learner-Centered Design approach to establish a personalised adaptation framework for designing educational serious games and enhancing personalised knowledge delivery. The proposed framework decouples the game logic implementation and adaptation mechanism. It dynamically adapts the designed game objects and activities to personal learning objectives, learning levels and learning progress to achieve a non-linear learning sequence. Through synchronous real-time xAPI message exchange mechanisms, system components and learning content adaptation are enabled. The adaptation aims to fit personal learning objectives and provide a non-linear learning sequence in a game environment. The framework provides students with personalised learning experiences. A game named GhostCoder is implemented and used to evaluate the framework. Based on the externalised adaptive mechanism, the game content is adapted to the player's performance by adjusting the difficulty of the learning content within the game. Testing of the game in the lab environment has been performed. At the next stage, an evaluation will be conducted with the target groups of students.

Background: The proportion of young adults living in one-person households (OPHs) has increased remarkably worldwide. Recent literature suggests that socioeconomic development established favorable conditions for individuals to live alone. Few studies have yet examined the complex relationship between contextual-level socioeconomic development, individual-level factors, and living in OPHs. Methods: We drew data from a subsample of young adults (aged between 20 and 35) from China 1Š Population Sample Survey 2005 (ni = 582,139; nj = 345). Two-level random-intercept logistic regression models were employed to examine the relationship between prefecture-level socioeconomic development and living in OPHs. Two series of models, controlling for single and migrant statuses, and other sociodemographic variables, were estimated for male and female separately. Results: First, there are positive associations between singlehood/migration and living in OPHs. Being single or a migrant are the most important individual-level correlates of living alone. Second, we found a strong positive curvilinear correlation between prefecture-level development and living alone that are well explained by the concentration of internal migrants but not the proportion of singles in the developed regions. Third, after controlling for migrant status, we only found a weak positive contextual effect of development on living alone. Yet, there are cross-level interaction effects that the associations between prefecture-level development and living alone are strong for single and migrant adults. Contribution: Our findings highlight the relative importance of internal migration over singlehood in explaining the concentration of OPHs in developed areas, which has important implications on the geographical patterns of OPHs among young adults.