Whose Shared Destiny?

THE ‘COMMUNITY OF SHARED DESTINY’ is not a completely new concept in Chinese foreign policy — the Communist Party first used the term in 2007 in relation to cross Strait relations. But it is one that has gained greater prominence over the past year. A key development during this period was Xi Jinping’s October 2013 keynote speech at the ‘Workshop on Diplomatic Work with Neighbouring Countries’ 周边国家外交工作座谈会, during which he elaborated on the ‘shared destiny’ theme (sometimes translated into English as ‘common destiny’): it was then that the term officially entered the Chinese foreign policy lexicon

Differences in the Experience of Caregiving Between Spouse and Adult Child Caregivers in Dementia With Lewy Bodies.

Background and objectivesDementia caregiving has been associated with increased burden, depression, grief, a decreased sense of well-being and quality of life, and a weakening of social support. Little is known about the experience of caregiving in Dementia with Lewy Bodies (DLB). The present study examines differences in the caregiving experience of spouse versus adult child caregivers of individuals with DLB.Research design and methodsIn this cross-sectional analytic study of spouses (n = 255) and adult children (n = 160) caregivers of individuals with DLB, participants completed an online survey of burden, grief, depression, well-being, quality of life, and social support.ResultsAdult child caregivers were more likely to care for women (p < .001) and see the care recipient less often (p < .001) than spouses. Adult child caregivers reported lower quality of life (p < .001) and more caregiver burden (p < .009), but also greater social support (p < .001) than spouses. Between group analyses of caregiver type by disease severity demonstrated that spousal caregivers experience greater grief with advancing disease (p = .005), while adult child caregivers increase social support with advancing disease (p < .001).Discussion and implicationsSpouses and adult children experience DLB caregiving differently. This was explained by the younger age of the adult child caregiver, frequency of contact with the care recipient, and differences in the care recipient's characteristics, frequency of neuropsychiatric symptoms, and disease severity. DLB caregiver support for this population should target psychoeducation for complicated neuropsychiatric symptoms in the care recipient. Screening all DLB caregivers for burden, grief, and depression is suggested to identify those that may benefit most from intervention. Spouses specifically may benefit from interventions that target increasing social support, while adult child caregivers may benefit from interventions aimed at mitigating burden and improving quality of life

Social Impact Measurement (SIM) experiencing and future Directions for the third sector organisations in the east of England.

Exploring ways to measure impact is not a new focus for the third sector or social enterprises, but one that is becoming more of a concern as organisations look for ways to improve what they do and demonstrate their impact to others. In part this requires a shift in thinking from measuring outputs to measuring outcomes, and the challenge is to find ways of measuring the softer elements related to social inclusion. There is also interest from outside of organisations with pressure from philanthropic funds and public service commissioners to find ways of making their decisions on how resources are allocated. Social Impact Measurement (SIM) is the process by which an organisation provides evidence that its services are providing real and tangible benefits to people or the environment (SEEE 2009). Issue 2 of the EEDA Social Impact Measurement (SIM) project examines a range of SIM models currently adopted by Third Sector Organisations and social enterprises. The aim is “Ultimately …. to gain a better understanding of the various social impact measurement models” (EEDA ITT 2009-082). Through the study of the experiences of a set of organisations, this research will examine why organisations are measuring impact, how they are doing this, the challenges they face and how these can be overcome. This will involve a review and evaluation of a wide range of tools used by third sector organisations to measure the impact of the work they do. It will provide guidance to assist Third Sector Organisations in selecting approaches to measuring impact and help public authorities to assess the claims made by those who are using impact measurement tools. The research has involved a review of the literature and over 40 different methods commonly in use in the UK. Following the development of questionnaires, interviews were carried out with 40 third sector organisations, 32 of whom had carried out social impact measurement. A further 10 organisations or individuals providing training in social impact measurement to organisations in the East of England Region were also interviewed. Data was also collected on the issues raised by the attendees of two training courses on social impact measurement, one covering Social Return On Investment (led by Kate Lee) and one covering Social Accounting and Audit (led by John Pearce) each of which had 12 participants. Finally feedback from participants of two workshops, each with approximately 50 attendees, has been integrate

Comparison of the Caregiving Experience of Grief, Burden, and Quality of Life in Dementia with Lewy Bodies, Alzheimer’s Disease, and Parkinson’s Disease Dementia

Background: Caregivers of persons living with Alzheimer’s disease (AD), dementia with Lewy bodies (DLB), and Parkinson’s disease dementia (PDD) are faced with numerous challenges. However, little is known about the caregiving experience across different dementias. Objective: The aims of this cross-sectional study were to examine the differences in the caregiver experience between DLB, PDD, and AD. Methods: Respondents were caregivers (N = 515; 384 DLB, 69 AD, 62 PDD) who completed a 230-question survey including sociodemographics, disease severity, neuropsychiatric symptoms, and measures of grief, burden, depression, quality of life, social support, well-being, care confidence, and mastery/self-efficacy. Results: There were no differences in caregiver age, sex, race, or education, or in the distribution of disease severity between diagnostic groups. Constructs were highly intercorrelated with positive attributes (caregiver QoL, care recipient QoL, social support, well-being, mastery and care confidence) being inversely correlated with negative attributes (burden, grief, and depression). Across dementia etiologies, no differences were reported for quality of life, social support, depression, well-being, psychological well-being, mastery, care confidence, burden or grief. Instead, we found that the caregiver’s experience was dependent on caregiver characteristics, person living with dementia characteristics and their most disturbing symptom, with behavior, personality changes, and sleep having the greatest effect on constructs. Conclusion: Caregiver ratings of psychosocial constructs may be more dependent on care recipient-caregiver dyad characteristics and the current symptoms than the underlying cause of those symptoms. Interventions to improve the caregiving experience should be developed to address specific psychosocial constructs rather than focusing on disease etiology or stage

DIFFERENCES IN CAREGIVER GRIEF AND BURDEN BETWEEN DEMENTIA WITH LEWY BODIES, DEMENTIA OF THE ALZHEIMER’S TYPE, AND DEMENTIA ASSOCIATED WITH PARKINSON’S DISEASE

Background: Caregiving for dementia has been associated with increased grief and burden. Dementia with Lewy Bodies (DLB) is the second most common form of dementia; yet, extant studies have focused primarily on caregivers of people with Alzheimer’s disease (AD). By result, the current state of the literature overlooks potentially important differences between caregivers of DLB and other dementia types. Caregivers of DLB face unique challenges early in their caregiving role; thus, it is likely that they experience grief and burden at earlier stages than other dementia types. The purpose of the present study was to examine the differences in the experience of grief and burden in caregivers of DLB versus caregivers of AD and Parkinson’s Disease with Dementia (PDD) at different disease stages. Method: Family caregivers of individuals with DLB (n = 415), AD (n = 71), or PDD (n = 66) completed a series of self-report online surveys. Results: Caregivers of DLB reported significantly more grief at earlier stages in the disease course than caregivers of AD. No significant differences in grief were found between caregivers of DLB and PDD. Caregivers for people with DLB, AD, and PDD had very similar profiles for burden. Implications: These findings support the hypothesis that there are differences in the experience of caregiving for those with DLB and other dementia types. More research is needed to investigate other potential differences in the caregiving experience for patients with DLB

Transoral laser surgery for laryngeal carcinoma: has Steiner achieved a genuine paradigm shift in oncological surgery?

Transoral laser microsurgery applies to the piecemeal removal of malignant tumours of the upper aerodigestive tract using the CO2 laser under the operating microscope. This method of surgery is being increasingly popularised as a single modality treatment of choice in early laryngeal cancers (T1 and T2) and occasionally in the more advanced forms of the disease (T3 and T4), predomi- nantly within the supraglottis. Thomas Kuhn, the American physicist turned philosopher and historian of science, coined the phrase ‘paradigm shift’ in his groundbreaking book The Structure of Scientific Revolutions. He argued that the arrival of the new and often incompatible idea forms the core of a new paradigm, the birth of an entirely new way of thinking. This article discusses whether Steiner and col- leagues truly brought about a paradigm shift in oncological surgery. By rejecting the principle of en block resection and by replacing it with the belief that not only is it oncologically safe to cut through the substance of the tumour but in doing so one can actually achieve better results, Steiner was able to truly revolutionise the man- agement of laryngeal cancer. Even though within this article the repercussions of his insight are limited to the upper aerodigestive tract oncological surgery, his willingness to question other peoples’ dogma makes his contribution truly a genuine paradigm shift

Guilt, shame and expressed emotion in carers of people with long-term mental health difficulties:a systematic review

Expressed emotion (EE) is a global index of familial emotional climate, whose primary components are emotional over-involvement (EOI) and critical comments (CC)/hostility. There is a strong theoretical rationale for hypothesising that carers’ guilt and shame may be differentially associated with their EOI and CC/hostility respectively. This systematic review investigates the magnitude of these theorised associations in carers of people with long-term mental health difficulties. Electronic searches (conducted in May 2016 across Medline, CINAHL, Embase, PsycINFO and ProQuest) were supplemented with iterative hand searches. Ten papers, reporting data from eight studies, were included. Risk of bias was assessed using a standardised checklist. Relevant data were extracted and synthesised narratively. EOI was positively associated with both guilt and shame, whereas CC/hostility was positively associated with shame. The strength of associations varied depending on whether or not guilt and shame were assessed within the context of the caring relationship. Based on these data, an argument can be made for the refinement, development and evaluation of systemic and individual interventions designed to target carers’ guilt and shame. However, more research is needed to clarify the strength of these associations and their direction of effect before firm conclusions can be drawn

Foreign Policy For A Global China

IS RISING China becoming ‘civilised’ or is it becoming a civilising force? Analysts of Chinese foreign policy have long grappled with this question. During the mid-1990s, for instance, the American analyst Denny Roy described China as a ‘hegemon on the horizon’, a rising power bent on dominating the Asia-Pacific over the longer term — through the use of force if necessary. By contrast, a more optimistic analysis by Princeton academic G. John Ikenberry in 2008 suggested that China could be ‘civilised’ and effectively incorporated into the Western-led liberal order. The larger debate is unresolved, and may remain so for years, perhaps even decades to come. Acknowledging the enormity of the task, this chapter seeks to shed additional light on the question by examining what we judge to be the five major foreign policy issues that China faced in the 2012–2013 period