Search Results (1,732)

In the Vaibhāṣika system, possession (prāpti), classified as a factor that is neither material nor mental, is posited as a real entity that links the various dharmas associated with a sentient being to its individual continuum. In this context, possession does not refer to legal ownership or supernatural possession; rather, it refers to the attainment or endowment of dharmas, that is, how particular qualities, actions, or mental states come to be present in a given individual. This paper examines the strategies by which Vaibhāṣikas defend the ontological status of possession, thereby shedding light on the motivations underlying this doctrinal commitment. Through close philological and historical analysis of a wide range of Sarvāstivāda Abhidharma sources, including passages from a newly available manuscript folio of the Abhidharmadīpa with Vibhāṣāprabhāvṛtti, this study reconstructs the diachronic development of Vaibhāṣika arguments for the real existence of possession. Vaibhāṣikas consistently employ two principal modes of justification: appeals to scriptural authority (āgama) and logical reasoning (yukti). As the tradition develops, their defenses of possession shift from reliance on scriptural sources toward increasingly sophisticated forms of doctrinal and functional integration. Possession thus evolves from a dharma serving to clarify specific doctrinal difficulties into a structurally embedded component of Vaibhāṣika doctrinal architecture, playing an important role in its accounts of soteriology, causality, and karma. Full article

Background: Unplanned hospitalizations in patients with cancer are associated with adverse outcomes, including intensive care unit (ICU) transfer and in-hospital mortality. This study aimed to evaluate the predictive role of the prognostic nutritional index (PNI) and albumin-to-globulin ratio (AGR) for these outcomes in patients with unplanned hospitalization in a medical oncology ward. Methods: This retrospective, single-center study included patients aged ≥18 years with malignancy who had unplanned hospitalization between 1 January and 30 April 2025. PNI and AGR were calculated at admission. The primary outcome was ICU transfer or in-hospital mortality. Univariable and multivariable logistic regression analyses were performed, with AGR and PNI evaluated in separate models to avoid collinearity. Predictive performance was assessed using ROC analysis. Results: A total of 418 patients were included, with adverse clinical outcomes in 26.8%. Metastatic disease was present in 73.7%, and gastrointestinal (41.6%) and lung cancers (21.5%) were most common. In univariable analysis, metastatic disease (p < 0.001), Eastern Cooperative Oncology Group (ECOG) performance status (p < 0.001), cancer type (p = 0.030), reason for hospitalization (p = 0.001), AGR (p < 0.001), and PNI (p < 0.001) were significantly associated with adverse clinical outcomes. In multivariable analyses performed in separate models, ECOG ≥ 2 emerged as the strongest independent predictor of adverse clinical outcomes (AGR model: OR: 9.93; PNI model: OR: 11.14; both p < 0.001). Metastatic disease remained an independent risk factor, while higher AGR and PNI values were independently associated with a reduced risk (all p < 0.05). Among hospitalization reasons, only electrolyte imbalance/transfusion was associated with a lower risk, whereas most cancer type subgroups were not independently significant. Both indices showed moderate predictive performance, with PNI performing slightly better than AGR (AUC: 0.729 vs. 0.707). Conclusions: ECOG performance status, together with PNI and AGR, were identified as practical and accessible predictors of adverse clinical outcomes in patients with unplanned hospitalization in a medical oncology ward. Full article

Background/Objectives. Abdominal computed tomography (CT) radiology reports contain critical information for abdominal aortic aneurysm (AAA) management, including aneurysm presence, size, rupture status, and prior repair. However, this information is often embedded within lengthy, heterogeneous reports, making manual extraction inefficient. We evaluated the performance of multiple large language models (LLMs) for automated extraction of AAA-related findings from radiology reports. Methods. We retrospectively analyzed 500 abdominal CT reports mentioning AAA from an urban academic health system (2020–2024). Ground truth labels were established by manual review. Four open-source LLMs (Qwen2.5-7B-Instruct, Llama3-Med42-8B, GPT-OSS-20B, and MedGemma-27B-text-it) were evaluated for extraction of aneurysm presence, size, morphology, rupture status, impending rupture, and prior aortic repair. Model outputs were compared with ground truth using exact-match accuracy, and inter-model agreement was assessed using Fleiss’ kappa. Reasoning traces were examined to characterize correct and incorrect model behavior. Results. Accuracy for identifying AAA presence ranged from 0.90 to 0.95 (κ = 0.851), and prior aortic repair from 0.90 to 0.97 (κ = 0.793). Accuracy for aneurysm size ranged from 0.67 to 0.88 (κ = 0.340), with low κ’s due to class imbalance or dimension misselection. Rupture and impending rupture were identified with accuracies exceeding 0.90 across models, though agreement was lower (κ = 0.485 and 0.589), reflecting low event prevalence. Larger models (GPT-OSS-20B, MedGemma-27B) generally outperformed smaller models. Reasoning analysis revealed strengths in measurement prioritization but recurrent errors, including dimension misselection, over-inference of prior repair, and conservative classification of rupture-related findings. Conclusions. LLMs can accurately extract clinically relevant AAA information from radiology reports with interpretable reasoning, with larger and medically trained models outperforming smaller or general-purpose models. Performance varies by task and model, underscoring the need for careful validation and human-in-the-loop deployment in clinical settings. Full article

Background: Nursing homes are congregate settings for elderly individuals where infectious diseases can easily spread. The elderly are at high risk of contracting and dying from influenza, and the most effective way to prevent this is to receive the influenza vaccine. Methods: This study conducted a cross-sectional survey of elderly people in nursing homes to investigate the occurrence of influenza symptoms during the 2024–2025 flu season, as well as vaccination status and reasons for receiving or not receiving the vaccine. Bivariate logistic regression was used to determine the factors influencing the vaccination rate. Results: Of the 1024 elderly people who participated in the survey, 25.39% reported experiencing flu-related symptoms in the previous flu season. While 16.21% of the elderly expressed willingness to receive vaccination, only 5.57% actually received it. Influenza vaccination was positively correlated with educational attainment (aOR 3.800, 95% CI 1.480–9.758 for middle school; aOR 5.138, 95% CI 1.738–15.191 for high school), monthly household income (aOR 0.216, 95% CI 0.072–0.644 for >8000), ability for self-care (aOR 0.269, 95% CI 0.123–0.591), and the scale of the nursing home (aOR 9.033, 95% CI 1.531–53.305 for 151–299; aOR 2.629, 95% CI 1.359–5.084 for ≥300). Willingness to receive the influenza vaccination was positively correlated with an unhealthy health status (aOR 0.398, 95% CI 0.204–0.779), symptoms of influenza (aOR 2.730, 95% CI 1.861–4.007), nursing home location (aOR 1.537, 95% CI 1.099–2.941 for outer suburbs), and the scale of the nursing home (aOR 1.991, 95% CI 1.154–3.435 for 151–299; aOR 2.158, 95% CI 1.374–3.390 for ≥300). Most elderly people who received the vaccine believed that vaccination could effectively prevent flu and that it could reduce the risk of complications, the rest were not vaccinated due to concerns about adverse reactions, mobility issues, or the distance to vaccination sites. Conclusions: Low awareness of flu vaccines and physical inability to travel to vaccination sites may be potential barriers to receiving the flu vaccine. It is worrying that the influenza vaccination rate is low among the elderly in nursing homes in Shanghai. As a result, it is crucial to prioritize targeted monitoring and intervention strategies for vulnerable populations living in collective institutions. Full article

Background: Age-related cognitive deccline is a significant health issue in Spain, especially among adults over 60 years of age. Addressing this involves establishing intervention guidelines and identifying early diagnostic biomarkers. Objective: To evaluate changes in urine of Brain-Derived Neurotrophic Factor, concentration and cognitive performance after the implementation of the multicomponent CESPORT program (incorporating a Mediterranean Diet, nutritional education, and continuous support). Methods: This controlled trial included 76 older adults, divided into an experimental group (n = 58; mean age 66.9 years; 75.9% female) that participated in the CESPORT program, and a control group (n = 18; mean age 68.8 years; 72.2% female). Cognitive performance was assessed using the Mini-Mental State Examination (MMSE) and the Cognifit^® battery. Urinary BDNF concentrations were quantified via ELISA. Results: After adjusting for baseline scores via ANCOVA, the experimental group demonstrated significantly higher post-intervention outcomes compared to the control group (p < 0.001). Substantial improvements with medium-to-large effect sizes were observed in global cognition, reasoning, attention, coordination and perception. Furthermore, urinary BDNF levels were significantly elevated in the experimental group. Positive correlations were found between Brain-Derived Neurotrophic Factor concentrations and cognitive performance in multiple domains (p < 0.05), particularly regarding global status and reasoning. Conclusions: The multicomponent CESPORT intervention demonstrates a potential protective effect against age-related cognitive decline. Furthermore, urinary BDNF emerges as a promising, non-invasive early biomarker for cognitive health. Further research is warranted to validate these findings. Full article

Background: Several factors influence reasons for cannabis use in the U.S. This study examines reasons for cannabis use (recreational only, medical only, both) and their frequency of use in association with demographic variables, health-risk behaviors, legal status, and chronic disease. Methods: We performed a cross-sectional analysis of 466,355 adults (aged ≥18) in the 2018–2021 BRFSS surveys in areas that administered the cannabis module. The primary outcome variables were whether cannabis was used in the past 30 days and, if so, reasons for its use and the number of days of use. Regression techniques were used to assess these outcome measures according to selected variables. Results: Approximately 11.5% (SE = 0.1%) used cannabis in the past 30 days. The reasons for use were 36.7% (SE = 0.5%) recreation only, 36.4% (SE = 0.5%) medical and recreation, and 26.9% (SE = 0.4%) medical only. Cannabis use was significantly greater in areas where it was legal for medical and recreational use, but among those who used it, reasons for its use were not significantly associated with legal status. Among those who used cannabis in the past 30 days, using it for recreation only versus medical reasons only was significantly greater in the youngest age group, men, NH Blacks, never married, employed, students, college/technical school graduates, binge drinkers, never smokers, and non-obese and in the years 2020–2021 (vs. 2018–2021). Using it for both medical and recreational reasons versus medical reasons only tended to show similar results. Among those who used cannabis in the past 30 days, the mean number of days of cannabis use was 6.8 (SE = 0.3) days greater for those who used it for medical and recreational reasons vs. recreation only and 5.7 (SE = 0.3) days greater for those who used it for medical reasons only vs. recreation only, after adjusting for several potential confounders. Mean number of days of cannabis use varied significantly across the levels of several variables, including chronic disease status, in the adjusted model. Of those who used cannabis in the past 30 days and had arthritis, asthma, CHD, COPD, depression, diabetes, a heart attack, kidney disease, or cancer, less than half used it for medical purposes only. Conclusions: Cannabis use is more common in areas where it is legal for medical and recreational use, but legal status is not significantly associated with reasons for use. Those who use cannabis for medical purposes use it more often than those who use it for recreation only. Reasons for cannabis use vary by the levels of several variables, including chronic disease status. Less than half of those with a chronic disease use it solely for medical purposes. Full article

Suicide is a major public health problem worldwide, and its reported reasons and methods show marked variation by gender and age. Although suicide rates are generally higher among men, suicides among women demonstrate distinct sociodemographic and age-related patterns that remain insufficiently explored. In Türkiye, national suicide statistics are available; however, nationwide, age-stratified analyses focusing exclusively on women are limited. This study aimed to investigate long-term trends, age-related differences in reported reasons and methods of suicide among women in Türkiye, and to provide insights relevant to age- and gender-sensitive prevention strategies. This retrospective, nationwide descriptive study analysed female suicide data obtained from the Turkish Statistical Institute between 2009 and 2023. A total of 12,868 female suicide cases were included (mean age 36.5 ± 19.3 years). Data were evaluated according to year, age group, marital status, educational level, suicide cause, and suicide method. Causes and methods were classified based on official administrative categories. Descriptive statistics were calculated, and associations between age groups and suicide causes and methods were assessed using Pearson’s chi-square test. During the 15-year study period, 12,868 women died by suicide in Türkiye. The annual suicide rate ranged from 1.81 to 2.46 per 100,000 population, with the lowest rate observed in 2017 and the highest in 2022. Among all age groups, the most frequent cause of suicide was illness, especially in women aged 45 and older. The proportion of suicides due to illness was 13.9% in the 15–24 age group, 24.6% in 25–34, 41.0% in 45–54, and 42.3% in 55–64 (p < 0.001). Emotional and relationship-related causes were more prevalent among younger women, particularly in the 15–24 age group (4.8%), but declined significantly with age (p < 0.001). Economic hardship was the least cited cause overall, especially among women under 35 (p < 0.001). Regarding methods of suicide, hanging was the most common method in all age groups and increased with age—35.8% in 15–24, 55.1% in 45–54, and 63.5% in 75+ age group (p < 0.001). The use of chemical substances peaked in the 15–24 age group (12.4%) and declined in older women (5.8% in 75+). Firearm use showed a significant inverse relationship with age, from 24.6% in those under 15 to 0.8% in women aged 75 and over (p < 0.001). These age-related differences in both the causes and methods of suicide were statistically significant (p < 0.001). Female suicide in Türkiye exhibits pronounced age-dependent differences in both causes and methods. Illness-related suicides and hanging predominate in older age groups, while younger women show a more diverse pattern of reported reasons and methods. The high prevalence of nonspecific classifications highlights limitations in current suicide reporting systems. These findings underscore the need for improved suicide classification, enhanced surveillance, and age- and gender-sensitive prevention strategies tailored to women across the lifespan. Full article

In this paper, by means of a comprehensive analysis of the statutory and non-statutory documents that govern its preschool provision, we examine how early childhood education and care (ECEC), particularly in relation to mathematics, is conceptualised by the English educational authorities. Situated within international debates about economic (school-readiness, accountability-driven) versus social (holistic, play-based, rights-oriented) models of ECEC, the study explores how curriculum expectations, assessment practices and didactical guidance collectively frame young children’s learning opportunities. Drawing on a document-based analytic approach, and guided by six literature-derived questions, the analysis reveals significant inconsistencies both within and between documents, including conflicting messages about the purpose of preschool, an uneven emphasis on school readiness, and ambivalent statements regarding the role of play, instruction and practitioner agency, as well as contradictory and shifting expectations surrounding the scope, status and pedagogical treatment of early mathematics. While statutory materials frequently privilege school readiness and narrowly defined number outcomes, non-statutory guidance promotes broader mathematical thinking, exploratory play and child-initiated reasoning. Overall, the findings demonstrate limited coherence across the English authorities’ ECEC expectations and highlight the interpretive and professional challenges faced by practitioners expected to implement this fragmented early years mathematics policy landscape. Full article

Background/Objectives: Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide and causes cervical cancer in women. Patients with human immunodeficiency virus (HIV) are particularly susceptible to this virus. An effective vaccine against high-risk HPV genotypes is available. This study sought to evaluate barriers to HPV vaccination in HIV-positive female patients between the ages of 18 and 65 in a county clinic in Houston. Methods: A cross-sectional survey was conducted in May–June 2025 with 131 patients at Thomas Street Health Center in Houston. The survey assessed patient demographics, attitudes toward and knowledge of HPV vaccination (at least one dose), as well as self-reported cervical dysplasia and HPV infection history. Clinical data on available cervical dysplasia history were also gathered from the electronic medical record. Descriptive statistics were compiled, and comparisons between vaccinated and unvaccinated participants were performed using one-way analysis of variance for continuous variables and chi-square tests for categorical variables in R. Results: 75% of patients had prior knowledge of the HPV vaccine, but only 33% reported receiving at least one dose. The most common reason for not receiving the vaccine was never having been offered the vaccine by a provider. Separately, almost 40% of unvaccinated individuals had never heard of the vaccine. Of note, only 8.6% of respondents reported fully understanding the implications of vaccination and still choosing to decline. In this cross-sectional study, there was no statistically significant association between vaccination status and either recent dysplasia history in the electronic record or reported dysplasia or HPV infection history. Among eligible unvaccinated participants, 41% received the HPV vaccine after completing the survey. Conclusions: Addressing gaps in HPV vaccine communication and supporting clinicians in delivering confident counseling may improve vaccination rates in this at-risk population. Full article

Background/Objectives: Decision making for contralateral prophylactic mastectomy in patients with breast cancer involves complex risk–benefit trade-offs that may lead to decisional conflict. Understanding factors associated with decisional conflict, particularly for patients with pathogenic variants in BRCA genes, is critical for developing tailored decisional support. This study examined decisional conflict, shared decision making, and decisional role preferences in Korean patients with breast cancer considering contralateral prophylactic mastectomy, focusing on factors associated with clinically significant decisional conflict and differences by BRCA status. Methods: A cross-sectional, internet-based survey was conducted between August and October 2024. Independent t-tests, univariate, and multivariate logistic regression analyses identified factors associated with clinically significant decisional conflict. Results: The sample included 167 Korean patients with breast cancer (90 BRCA carriers and 77 non-carriers). Most patients (76%) experienced clinically significant decisional conflict. Non-carriers reported higher decisional conflict (44.2 vs. 29.3, p < 0.001) and lower shared decision making than BRCA carriers (44.6 vs. 61.9, p < 0.001). Role preferences were similarly distributed across groups (50.3% active, 24.0% collaborative, 25.7% passive). In multivariable analysis, clinically significant decisional conflict in the total sample was associated with non-carrier status (OR = 2.98) and lower shared decision-making scores (OR = 0.94) (p < 0.05), explaining 28% of the variance. Among BRCA carriers, clinically significant decisional conflict was associated with lower shared decision-making scores (OR = 0.92) and passive role preferences (vs. active) (OR = 4.88). No variables were significantly associated with decisional conflict among non-carriers. Conclusions: Findings suggest that decisional conflict is influenced by genetic risk and the quality of the decision-making process. Improving patient engagement by identifying preferred decisional roles, understanding the reasons behind these preferences, and encouraging shared decision making may help reduce decisional conflict, particularly among BRCA carriers. Further research is needed to better understand factors associated with decisional conflict among non-carriers. Full article

Risk assessment for immediate mortality is a vital component of the preoperative assessment in elective cardiac surgeries of the adult population. It is generally used to inform consent and plan postoperative care, but can also help identify patients who need preoperative optimization. Risk assessment for open cardiac interventions remains difficult, as an absolute risk assessment tool is still lacking. In this narrative review, we examine recent data on the predictive performance of commonly used risk assessment tools in cardiac surgery and explore missed opportunities to improve predictive performance, including overlooked independent predictors and alternative calculation strategies, such as machine learning. The literature shows that the most popular risk assessment tools are the Parsonnet score, EuroSCORE II, STS-PROM, and ACEF. These have reasonable discriminative capabilities across most populations but occasionally suffer from poor calibration and over- or underprediction. Preoperative inflammation, functional status, physical performance, nutrition, and frailty are potentially relevant clinical factors that could improve mortality prediction modeling using traditional approaches. By far, the largest advancement comes from artificial intelligence-based models that demonstrate superior predictive capabilities utilizing the same predictors. These models are still in development, have not received external validation, are not yet trusted by physicians, and may not be accessible to all institutions due to computing limitations, and thus are not ready for global rollout. Further research in identifying novel predictors of mortality is required, and efforts are needed to validate machine learning models in external cohorts. Full article

Purpose: HER2-targeted therapy has been incorporated into the standard neoadjuvant treatment (NAT) regimen for HER2-positive early-stage breast cancer, yet a subset of patients have shown a limited pathological response. This study aimed to evaluate clinicopathological factors associated with NAT sensitivity and to develop a predictive model. Methods: This retrospective study included 13,004 HER2-positive breast cancer patients from the National Cancer Database (2010–2022) who received neoadjuvant chemotherapy plus HER2-targeted therapy. Pathological complete response (pCR) was defined as no residual invasive carcinoma in the breast and axillary lymph nodes (ypT0/is, ypN0). NAT sensitivity was additionally defined using clinical-to-pathologic stage migration according to the AJCC 8th edition criteria. Baseline characteristics and overall survival (OS) were compared between NAT-sensitive and NAT-insensitive groups. A multivariable logistic regression model was developed based on age, clinical T stage, clinical N stage, histologic subtype, tumor grade, and hormone receptor (HR) status. Model performance was assessed using the area under the receiver operating characteristic curve and calibration curves. Results: Among the patients included, 3660 (28.1%) achieved pCR. Based on the predefined stage-based criteria, 10,451 (80.4%) were classified as NAT-sensitive and 2553 (19.6%) as NAT-insensitive. NAT-insensitive patients were older and more likely to present with clinical T1c and node-negative disease, whereas NAT-sensitive patients more frequently had higher clinical T and N stages. HR-positive and lower tumor grades were significantly associated with treatment insensitivity. NAT-insensitive patients demonstrated significantly worse OS compared with NAT-sensitive patients (p < 0.001). The predictive model showed acceptable discrimination with AUCs of 0.762 in the training cohort and 0.776 in the validation cohort, demonstrating good calibration. Conclusions: NAT sensitivity in HER2-positive early-stage breast cancer exhibited substantial biological and clinical heterogeneity in real-world practice. A younger age, higher clinical stage, invasive ductal histology, higher tumor grade, and HR-negative status were associated with improved responses. A predictive model based on routinely available baseline variables demonstrated reasonable performance for estimating treatment sensitivity, supporting its potential utility for baseline risk stratification pending external validation. Full article

The use of telemedicine by the Ultra-Orthodox (UO) population in Israel presents challenges due to unique cultural characteristics, including limited internet use for religious ideological reasons and lower levels of digital literacy. This cross-sectional survey examines the rate of telemedicine use in the UO society in Israel according to religious groups, factors, attitudes and barriers associated with telemedicine use. The study included 1460 adult UO participants using quota by gender, and religiosity groups. The participants underwent a phone interview assessing telemedicine use (defined as at least one monthly phone/video call/e-mail correspondence with a medical professional, during the last year), attitudes, and perceived barriers. In total, 39% of participants used telemedicine and 42% performed one or more administrative actions. Phone consultations were the most common mode of communication with healthcare providers. The main barrier to using telemedicine was religious-ideological. Multiple logistic regression revealed that female sex, participants aged 30–44, married status, above-average income, frequent family physician visits, and internet use significantly associated with telemedicine use. Compared to <30, adults aged 60+ years use less telemedicine (OR 0.52, 95% CI 0.32–0.86). These findings indicate telemedicine use within the UO population, though substantial cultural barriers remain, and may assist policymakers in expanding its implementation. Full article

Background and Objectives: This study aimed to identify the clinical factors associated with the need for surgical intervention in women with uterine fibroids (UFs) and develop a data-driven clinical decision helper algorithm. By comparing hematologic and fibroid characteristics and prospectively assessing clinical concordance with the model predictions, we sought to create an objective tool for surgical decision-making. Materials and Methods: This retrospective study enrolled 618 women with UFs who were evaluated at three participating hospitals. Of these, 238 (38.5%) underwent surgery. Comparative statistical analyses were conducted between patients who underwent myomectomy and those who did not. Machine learning (ML) models were trained to predict myomectomy necessity. A clinical concordance assessment was conducted using 50 cases that were evaluated in real time by a gynecologist blinded to both the clinical outcomes and the model outputs. Agreement between clinical assessment and algorithm-based predictions was subsequently evaluated. Results: Hemoglobin and ferritin concentrations were significantly reduced in the surgery group compared with the non-surgery group (p < 0.001). ML analyses integrating fibroid characteristics with anemia-related markers identified support vector ML models as the most accurate classifiers. Ferritin-based models achieved accuracies of 98–99% and near-perfect ROC–AUC values. ML models combining UF number or volume with ferritin demonstrated the highest precision, sensitivity, and F1-scores. Clinical concordance analysis showed 98% agreement with the blinded gynecologist, with only one borderline discordant case. Conclusions: This decision helper algorithm provides a highly accurate and objective tool for predicting surgical necessity in patients with UFs. Anemia status and fibroid characteristics were the strongest predictors. By reducing subjective variability and closely reflecting expert reasoning, the model offers a practical framework for integration into routine gynecologic decision-making. Full article

This study investigated family language policies (FLP) in the current context of the Macao Special Administrative Region (Macao SAR). It explored family language ideologies, management strategies, and intergenerational practices through questionnaires, semi-structured interviews, and participant observations. The findings indicate that Macao permanent residents’ families take Cantonese Chinese as the primary medium of communication and cultural identity. Simultaneously, Mandarin and English are often valued for their roles in academic and professional advancement. Portuguese exhibits a trend of marginalization, despite remaining one of the official languages of the Macao SAR. As for other dialects, they may be used in family conversations but are not considered important languages. Beyond this hierarchy of language values, the researchers also revealed that the FLP of Macao’s permanent residents’ families tends to be driven by both experience and foresight, enabling family members to engage in effective consultation on language choice and language learning. Regarding language practice, children’s multilingual fluency is significantly better than that of their parents. The dominant family language tendency does not influence the consensus of multilingualism and allows code-mixing to appear in conversations. In this article, FLP in Macao families is found to be shaped by both experiential knowledge and future-oriented practical considerations, while also reflecting parents’ affective concerns and responses to broader structural pressures. All these factors together form a decision-making system. In this system, both emotion and reason play their roles simultaneously. If a hierarchical distinction must be made, the rational recognition of the diverse characteristics of the linguistic environment and the dominant status of the main language will be primary. Full article