照顧者實用資訊手冊

手冊源起 香港面對人口高齡化，醫療和福利系統無可避免面臨持續的挑戰。照顧者因壓力問題而引發的家庭悲劇時有發生，反映照顧者自身亦極需要社會的重視和支援。 現時照顧者人數眾多，當中不乏配偶、父母、子女、女婿、媳婦，對長者照顧及社會無酬的付出，確實值得社會的認同和肯定。然而，儘管本港為長者及照顧者提供不少支援服務，由於不同的原因，照顧者似乎未有善用現有的服務，常常需要一力承擔所有照顧的責任，這無疑增加了他們的壓力。 照顧者需求多樣性 照顧者有不同種類，所需要的服務或支援亦有所不同。例如：「新手照顧者」剛開始接觸照顧工作，需要盡快提升日常護理和相關的疾病知識，以及獲得合適的離院/復康服務支援。「隱蔽照顧者」一直承擔照顧工作但沒有接受任何支援，因此，他們需要的是服務提供者/鄰里的主動接觸，並被轉介合適的照顧服務，以分擔他們部分照顧工作。「高危照顧者」幾乎長時間被照顧的工作佔據了其生活，他們需要的是喘息空間和暫託服務，甚至可能是情緒支援。即使「資深的照顧者」也可能需要喘息或暫託的支援服務去減輕壓力；而結束了照顧工作的「畢業照顧者」，無論是情緒的支援，還是重新規劃財務與就業的安排，都有非常實際的需求。基於照顧者的不同需要，照顧者的支援和服務也是多樣化，如何讓不同種類的照顧者能夠輕易了解現有的社區支援服務、可考慮甚麼因素選取相關服務、如何獲取所需的支援包括申領經濟支援或預早準備長期護理開支、如何自強增值等，都是這本手冊希望解答的問題。 手冊的目的 編製這本手冊的目的就是要減少照顧者四處尋找資訊的麻煩，提供一個整全且易於瀏覽的資訊來源。本手冊主要有兩大目標：其一，幫助照顧者認識不同的服務和資源，積極尋求援助；其二是一站式提供豐富的資訊服務，提升照顧者的能力和平衡身心健康。 手冊的意義 此手冊的社會意義是期望提高大眾對照顧者需要的關注，並引導更多的行動以支援照顧者。如果您的親友是照顧者，又或您認識的朋友甚至鄰居正面對照顧家人的困難，您可以主動伸出援手，又或利用這本手冊作為啟示，向他們介紹相關的服務。 另外，這本手冊可以視作為支援照顧者的工具，讓照顧者明白在承擔照顧家人的重任時並不需要孤軍奮戰，也可以善用社區提供的各種資源和服務。 手冊架構 本手冊由四個主要部分組成，每部分都專注於特定的主題，旨在提供照顧者的全方位支援和資訊，幫助他們在面對挑戰時能夠有所依賴，並從中獲得力量： 第一部分主要提供基礎知識，其中包括不同種類的照顧者的介紹、四種長者常見疾病（包括認知障礙、中風、老年抑鬱和癌症）的病徵說明、以及照顧者可能面臨的壓力與「喘息服務」的重要性。第二部分專注介紹長者常用的社區及健康服務。我們按照地區將服務機構進行了分類，羅列「認知障礙、中風、老年抑鬱、癌症」常用的服務機構，此外，我們還提供家居安全、樂齡科技租賃服務，以及財務支援等相關建議。第三部分將焦點重新放回照顧者身上，提供了支援照顧者的社福機構介紹、照顧者同路人的心得分享，以及照顧者的培訓資訊，旨在幫助照顧者在面對困難時能自強不息。最後，在本手冊的結尾部分，我們特別邀請了四位專家學者就照顧者政策提出見解和建議，為加強照顧者支援服務提供新思路。 如果按持份者來分類，手冊的四個部分的重點如下： 第一部分：照顧者的基礎知識 ◎ 針對預備照顧者、新手以及隱蔽照顧者，讓他們了解照顧者的角色和需要；照顧體弱長者的基礎知識，並提供應對壓力的建議，包括自我照顧和喘息服務等。 第二部分：照顧者支援 ◎ 針對所有護老者，提供長者常用的社區服務、健康服務和支援計劃，包括暫託、住宿、護送及陪診、善別支援、情緒支援、復康用品津貼及租賃的支援計劃，以及財務策劃師提供的理財貼士。 第三部分：照顧者自強 ◎ 針對照顧者，資訊包括不同的照顧者支援組織、同路人和畢業照顧者的經驗心得、培訓課程，以及實用的電子資訊平台推介。 第四部分：對照顧者支援政策的看法和展望 ◎ 針對服務提供者、政策倡議者及制定者，提供專家學者對照顧者服務及政策的未來發展方向的看法和建議，以期引發更多關於「如何為照顧者提供更好支持」的討論。 給讀者的使用指引 本手冊內容十分豐富，讀者可以先瀏覽目錄，選擇與您相關的部分進行細讀。對於新手照顧者或剛接觸/關注護老服務的人士(例如：學生、社區人士)，我們建議您可以參考手冊第24-33頁「給照顧者的智慧錦囊」的個案，了解不同照顧者可能面對的情境，這可能會給您一點概念，讓您可以考慮尋求哪些支援服務，又或您身邊照顧者朋友有哪些需要，以及如何協助他們獲取所需要的支援。我們深知閱讀本手冊時，您可能會遇到一些不明白的地方，請不必感到困惑。您可以嘗試找身邊的朋友、鄰居或社會服務機構的工作人員一起閱讀，或者向本中心的職員進行查詢。 此外，為方便讀者可以隨時隨地閱讀而不需要攜帶整本手冊，我們為本手冊設立了一個專屬網頁，免費下載整本手冊或某些章節內容。 希望您在閱讀的過程中能找到有用的資訊，並能從中獲得實際的幫助。https://commons.ln.edu.hk/apias_guide/1009/thumbnail.jp

Dissecting the effects of METTL3 on alternative splicing in prostate cancer

Although the role of METTL3 has been extensively studied in many cancers, its role in isoform switching in prostate cancer (PCa) has been poorly explored. To investigate its role, we applied standard RNA-sequencing and long-read direct RNA-sequencing from Oxford Nanopore to examine how METTL3 affects alternative splicing (AS) in two PCa cell lines. By dissecting genome-wide METTL3-regulated AS events, we noted that two PCa cell lines (representing two different PCa subtypes, androgen-sensitive or resistant) behave differently in exon skipping and intron retention events following METTL3 depletion, suggesting AS heterogeneity in PCa. Moreover, we revealed that METTL3-regulated AS is dependent on N6-methyladenosine (m6A) and distinct splicing factors. Analysis of the AS landscape also revealed cell type specific AS signatures for some genes (e.g., MKNK2) involved in key functions in PCa tumorigenesis. Finally, we also validated the clinical relevance of MKNK2 AS events in PCa patients and pointed to the possible regulatory mechanism related to m6A in the exon14a/b region and SRSF1. Overall, we characterize the role of METTL3 in regulating PCa-associated AS programs, expand the role of METTL3 in tumorigenesis, and suggest that MKNK2 AS events may serve as a new potential prognostic biomarker

Sex- and age-dependent association of SLC11A1 polymorphisms with tuberculosis in Chinese: a case control study

BACKGROUND: Host genetic factors are important determinants in tuberculosis (TB). The SLC11A1 (or NRAMP1) gene has been studied extensively for genetic association with TB, but with inconsistent findings. In addition, no study has yet looked into the effect of sex and age on the relationship between SLC11A1 polymorphisms and TB. METHODS: A case-control study was conducted. In total, 278 pulmonary TB patients and 282 sex- and age-matched controls without TB were recruited. All subjects were ethnic Chinese. On the basis of linkage disequilibrium pattern, three genetic markers from SLC11A1 and one from the nearby IL8RB locus were selected and examined for association with TB susceptibility. These markers were genotyped using single strand conformation polymorphism analysis or fragment analysis of amplified products. RESULTS: Statistically significant differences in allele (P = 0.0165, OR = 1.51) and genotype (P = 0.0163, OR = 1.59) frequencies of the linked markers SLC6a/b (classically called D543N and 3'UTR) of the SLC11A1 locus were found between patients and controls. With stratification by sex, positive associations were identified in the female group for both allele (P = 0.0049, OR = 2.54) and genotype (P = 0.0075, OR = 2.74) frequencies. With stratification by age, positive associations were demonstrated in the young age group (age ≤65 years) for both allele (P = 0.0047, OR = 2.52) and genotype (P = 0.0031, OR = 2.92) frequencies. All positive findings remained significant even after correction for multiple comparisons. No significant differences were noted in either the male group or the older age group. No significant differences were found for the other markers (one SLC11A1 marker and one IL8RB marker) either. CONCLUSION: This study confirmed the association between SLC11A1 and TB susceptibility and demonstrated for the first time that the association was restricted to females and the young age group

The utility of screening for perinatal depression in the second trimester among Chinese: a three-wave prospective longitudinal study

This paper aims to study the pattern of perinatal depressive symptomatology and determine the predictive power of second trimester perinatal depressive symptoms for future perinatal periods. A population-based sample of 2,178 women completed the Edinburgh Postnatal Depression Scale (EPDS) in the second and third trimesters and at 6 weeks postpartum. Repeated measures ANOVAs were used to determine the EPDS scores across three stages. The predictive power of the second trimester EPDS score in identifying women with an elevated EPDS score in the third trimester and at 6 weeks postpartum were determined. The predictive power of the second trimester EPDS score was further assessed using stepwise logistic regression and receiver operator characteristic curves. EPDS scores differed significantly across three stages. The rates were 9.9%, 7.8%, and 8.7% for an EPDS score of >14 in the second and third trimesters and at 6 weeks postpartum, respectively. Using a cut-off of 14/15, the second trimester EPDS score accurately classified 89.6% of women in the third trimester and 87.2% of those at 6 weeks postpartum with or without perinatal depressive symptomatology. Women with a second trimester EPDS score >14 were 11.78 times more likely in the third trimester and 7.15 times more likely at 6 weeks postpartum to exhibit perinatal depressive symptomatology after adjustment of sociodemographic variables. The area under the curve for perinatal depressive symptomatology was 0.85 in the third trimester and 0.77 at 6 weeks postpartum. To identify women at high risk for postpartum depression, healthcare professionals could consider screening all pregnant women in the second trimester so that secondary preventive intervention may be implemented

Scalability of Quasi-Hysteretic FSM-Based Digitally Controlled Single-Inductor Dual-String Buck LED Driver to Multiple Strings

There has been growing interest in single-inductor multiple-output (SIMO) dc-dc converters due to its reduced cost and smaller form factor in comparison with using multiple single-output converters. An application for such a SIMO-based switching converter is to drive multiple LED strings in a multichannel LED display. This paper proposes a quasi-hysteretic finite-state-machine-based digitally controlled single-inductor dual-output buck switching LED driver operating in discontinuous conduction mode (DCM) and extends it to drive multiple outputs. Based on the time-multiplexing control scheme in DCM, a theoretical upper limit of the total number of outputs in a SIMO buck switching LED driver for various backlight LED current values can be derived analytically. The advantages of the proposed SIMO LED driver include reducing the controller design complexity by eliminating loop compensation, driving more LED strings without limited by the maximum LED current rating, performing digital dimming with no additional switches required, and optimization of local bus voltage to compensate for variability of LED forward voltage V-F in each individual LED string with smaller power loss. Loosely binned LEDs with larger V-F variation can, therefore, be used for reduced LED costs

Adaptive high-bandwidth digitally controlled buck converter with improved line and load transient response

Digitally controlled switching converter suffers from bandwidth limitation because of the additional phase delay in the digital feedback control loop. To overcome the bandwidth limitation without using a high sampling rate, this study presents an adaptive third-order digital controller for regulating a voltage-mode buck converter with a modest 2x oversampling ratio. The phase lag because of the analogue-to-digital converter (ADC) conversion time delay is virtually compensated by providing an early estimation of the error voltage for the next sampling time instant, enabling a higher unity-gain bandwidth without compromising stability. An additional pair of low-frequency pole and zero in the third-order controller increases the low-frequency gain, resulting in faster settling time and smaller output voltage deviation during line transient. Both simulation and experimental results demonstrate that the proposed adaptive third-order controller reduces the settling time by 50% in response to a 1 V line transient and 30% in response to a 600 mA load transient, compared to the baseline static second-order controller. The fastest settling time is measured to be about 11.70 mu s, surpassing the transient performance of conventional digital controllers and approaching that of the state-of-the-art analogue-based controllers

Wireless power link design using silicon-embedded inductors for brain-machine interface

This paper discusses the safety requirements, equivalent circuit model, and design strategy of wireless power transmission to neural implants. The most daunting challenge is the design of the integrated receiving coil on the implantable device whose size must be within the safety and regulation limits while providing sufficient power transfer and efficiency. A novel silicon substrate-embedded 3.6-H spiral inductor has been designed to fit inside a 4.5 mm 4.5 mm implantable IC as the receiving coil. Full-wave EM simulations show that in a practical brain-machine interface setting, wireless power in the range of 1-10 mW can be delivered at 5% efficiency to an implant at 1 cm below the head surface using signals between 2 to 5 MHz. To achieve a high transfer efficiency, the optimal impedance for loading the receiving coil is derived using the equivalent circuit parameters of a realistic 3D model of the entire wireless power link. The large parasitic capacitance of the in-chip inductor is methodically absorbed in the matching network to maximize the efficiency and power transfer. © 2012 IEEE

Silicon-Embedded Receiving Coil for High-Efficiency Wireless Power Transfer to Implantable Biomedical ICs

In this letter, a silicon-embedded receiving coil is designed and fabricated for high-efficiency wireless power transfer to implantable biomedical ICs. The 4.5 mm × 4.5 mm embedded receiving coil achieved a large inductance of 4 μ H and a high peak quality factor of 20 at 2.8 MHz. Measurement results of an inductive power link using the embedded receiving coil and a conventional printed-circuit-board transmitting coil (2 cm × 2 cm) demonstrated peak voltage gains of 0.84 and 0.24 and peak efficiency values of 30% and 4.3% for separation distances of 5 and 12 mm, respectively. This is the best reported wireless power transmission efficiency for separation distance similar to the implant chip size. © 2012 IEEE

Induction of T-cell response by a DNA vaccine encoding a novel HLA-A{*}0201 severe acute respiratory syndrome coronavirus epitope

The severe acute respiratory syndrome coronavirus nucleocapsid protein (SARS-CoV N) is one of the major targets for SARS vaccine due to its high potency in triggering immune responses. In this study, we have identified a novel HLA-A{*}0201 restricted epitope, N220 (LALLLLDRL), of the SARS-CoV N-protein through bioinformatics analysis. The N-protein peptide N220 shows a high binding affinity towards human MHC class I in T2-cells, and is capable of activating cytotoxic T-cells in human peripheral blood mononuclear cells (PBMCs). The application of using the N220 peptide sequence with a single-chain-trimer (SCT) approach to produce a potential DNA vaccine candidate was investigated in HLA-A2. I K-b transgenic mice. Cytotoxicity assay clearly showed that the T-cells obtained from the vaccinated animals were able to kill the N-protein expressing cells with a cytotoxicity level of 86\% in an effector cells/target cells ratio of 81:1 one week after the last vaccination, which is significantly higher than other N-protein peptides previously described. The novel immunogenic N-protein peptide revealed in the present study provides valuable information for therapeutic SARS vaccine design. (c) 2007 Elsevier Ltd. All rights reserved