Investigation of Student Nurses’Attitudes towards End-of-Life Care and Their Influencing Factors

Background: This cross-sectional investigative study aimed to determine student nurses’ attitudes towards end-of-life care. Methods: This study used a descriptive research design with stratified sampling to survey student nurses enrolled in one of four nursing colleges in China from January 2023 to December 2023. Student nurses’ general demographic and prior related information, attitudes towards death and attitudes towards end-of-life care were determined using a general information questionnaire, the Death Attitude Profile—Revised scale and the Professional End-of-Life Attitude Scale (PEAS), respectively. Results: The total PEAS score was 122.91 ± 16.123. Significant differences were noted in the attitude towards end-of-life care scores according to sources of end-of-life care knowledge (P Conclusions: Student nurses lacked an optimistic attitude towards end-of-life care, which was influenced by differences in the sources of end-of-life care knowledge.

基于互信息优化的Option-Critic算法

时序抽象作为分层强化学习的重要研究内容,允许分层强化学习智能体在不同的时间尺度上学习策略,可以有效解决深度强化学习难以处理的稀疏奖励问题。如何端到端地学习到优秀的时序抽象策略一直是分层强化学习研究面临的挑战。Option-Critic(OC)框架在Option框架的基础上,通过策略梯度理论,可以有效解决此问题。然而,在策略学习过程中,OC框架会出现Option内部策略动作分布变得十分相似的退化问题。该退化问题影响了OC框架的实验性能,导致Option的可解释性变差。为了解决上述问题,引入互信息知识作为内部奖励,并提出基于互信息优化的Option-Critic算法(Option-Critic Algorithm with Mutual Information Optimization,MIOOC)。MIOOC算法结合了近端策略Option-Critic(Proximal Policy Option-Critic,PPOC)算法,可以保证下层策略的多样性。为了验证算法的有效性,把MIOOC算法和几种常见的强化学习方法在连续实验环境中进行对比实验。实验结果表明,MIOOC算法可以加快模型学习速度,实验性能更优,Option内部策略更有区分度。

Naturally Nitrogen-Doped Biochar Made from End-of-Life Wood Panels for SO_(2) Gas Depollution

Reconstituted wood panels have several advantages in terms of ease of manufacturing,but their shorter life span results in a huge amount of reconstituted wood panels being discarded in sorting centers yearly.Currently,the most common approach for dealing with this waste is incineration.In this study,reconstituted wood panels were converted into activated biochar through a two-step thermochemical process:(i)biochar production using pilot scale fast pyrolysis at 250 kg/h and 450℃;and(ii)a physical activation at three temperatures(750℃,850℃ and 950℃)using an in-house activation furnace(1 kg/h).Results showed that the first stage removed about 66% of the nitrogen from the wood panels in the form of NO,NH3,and trimethylamine,which were detected in small amounts compared to emitted CO_(2).Compared to other types of thermochemical conversion methods(e.g.,slow pyrolysis),isocyanic acid and hydrogen cyanide were not detected in this study.The second stage produced activated biochar with a specific surface area of up to 865 m^(2)/g at 950℃.The volatile gases generated during activation were predominantly composed of toluene and benzene.This two-step process resulted in nitrogen-rich carbon in the form of pyrrolic and pyridinic nitrogen.Activated biochars were then evaluated for their SO_(2) retention performance and showed an excellent adsorption capacity of up to 2140 mg/g compared to 65 mg/g for a commercial activated carbon(889 m^(2)/g).End-of-life reconstituted wood panels and SO_(2) gas are problematic issues in Canada where the economy largely revolves around forestry and mining industries.

Learning from the Film “Mitorishi (Transition Doula)”—Application to Understanding the End-of-Life in a Gerontological Nursing Practice Course in Japan

Purpose: This study aims to detail what nursing students learned from watching the film “Mitorishi”, which was used among the teaching materials in a gerontological nursing practice course in nursing education in Japan, and demonstrate the applicability of using the film as an element relevant to the teaching of end-of-life care in Japan. Methods: The participants were fourth-year nursing students at University A who had watched the film “Mitorishi” during the course, had submitted a report on what they learned, and provided informed consent to the study participation. The reports submitted by the participants were used as data and analyzed qualitatively using the content analysis approach. Results: The analysis identified the following five categories (number of codes): Characteristics of life during the final days (9), Importance of views on life and death (3), Importance of end-of-life care (3), Assistance in preparation for the final days of life (13), and Understanding the profession of transition doula (9). Discussion: The five categories show that the students have learned about the “role of nurses at the time of end-of-life care” while “visualizing end-of-life care” and learning “preparedness for end-of-life care”. These findings suggest that using the film “Mitorishi” in the teaching curriculum is effective for learning about end-of-life care for older people.

Modeling the Spatio-Temporal Dynamics of Local Context for a Contextualized Diffusion of Agroecological Intensification Options in Niger

Spatio-temporal variability and dynamics in Sahelian agro-pastoral zones make each local situation a special case. These specificities must be considered to guide the dissemination of agricultural options with a view to sustainable development. The territorial scale of municipalities is not sufficient for this necessary contextualization;the scale of the “village terroir” seems to be a better option. This is the hypothesis we put forward in the framework of the Global Collaboration for Resilient Food Systems program (CRFS), i.e. local context is spatially defined by village terroir. The study is based on data collected through participatory mapping and surveys in “village terroirs” in three regions of Niger (Maradi, Dosso and Tillabéri). Then the links between farm managers and their cultivated land, as well as the spatio-temporal dynamics of local context are analyzed. This study provides evidence of the existence and functional usefulness of the village terroir for farmers, their land management and their activities. It demonstrates the usefulness of contextualizing agricultural options at this scale. Their analysis elucidates the links between “terroirs village” and the specific functioning of the agrosocio-ecosystems acting on each of them, thus laying the systemic and geographical foundations for a model of the spatio- temporal dynamics of “village terroirs”. This initial work has opened up new perspectives in modeling and sustainable development.

Research on Value Evaluation Method of Investment Project Based on Fuzzy Composite Real Options

Venture capital investments are characterized by high input,high yield,and high risk.Due to the complexity of the market environment,stage-by-stage investment is becoming increasingly important.Traditional evaluation methods like comparison,proportion,maturity,internal rate of return,scenario analysis,decision trees,and net present value cannot fully consider the uncertainty and stage characteristics of the project.The fuzzy real options method addresses this by combining real option theory,fuzzy number theory,and composite option theory to provide a more accurate and objective evaluation of Public-Private Partnership(PPP)projects.It effectively considers the interaction of options and the ambiguity of project parameters,making it a valuable tool for project evaluation in the context of venture capital investment.

Individualized Aromatherapy in End-of-Life Cancer Patients Care:A Case Report

As one of the methods of palliative care,aromatherapy has been applied gradually in clinical nursing work in China in recent years.Through aromatherapy,terminal cancer patients can get not only relieves of physical symptoms,but also spiritual relaxation and peace,thus have improved quality of life at the end stage.In this paper,we report in detail about how aromatherapy was applied for symptom control in a cancer patient with unknown primary malignancy and multiple metastasis and its effects on the terminal life of this patient.

Activity coefficients of NiO and CoO in CaO–Al_2O_3–SiO_2 slag and their application to the recycling of Ni–Co–Fe-based end-of-life superalloys via remelting

To design optimal pyrometallurgical processes for nickel and cobalt recycling, and more particularly for the end-of-life process of Ni-Co-Fe-based end-of-life（EoL） superalloys, knowledge of their activity coefficients in slags is essential. In this study, the activity coefficients of NiO and CoO in CaO-Al_2O_3-SiO_2 slag, a candidate slag used for the EoL superalloy remelting process, were measured using gas/slag/metal equilibrium experiments. These activity coefficients were then used to consider the recycling efficiency of nickel and cobalt by remelting EoL superalloys using CaO-Al_2O_3-SiO_2 slag. The activity coefficients of NiO and CoO in CaO-Al_2O_3-SiO_2 slag both show a positive deviation from Raoult＇s law, with values that vary from 1 to 5 depending on the change in basicity. The activity coefficients of NiO and CoO peak in the slag with a composition near B =（%CaO）/（%SiO_2） = 1, where B is the basicity. We observed that controlling the slag composition at approximately B = 1 effectively reduces the cobalt and nickel oxidation losses and promotes the oxidation removal of iron during the remelting process of EoL superalloys.

Living Conditions and Palliative Care Needs among End-of-Life Former Commercial Plasma Donors Affected with HIV/AIDS in Rural Henan of China

Objective China began providing antiretroviral therapy to people living with HIV/AIDS （PLWHA） in 2003. This study was to investigate the living conditions, including quality of life and happiness, and need for palliative care of end-of-life PLWHA in rural Henan. Methods One hundred end-of-life AIDS patients were selected from Weishi, Zhenping and Tanghe counties in Henan, using convenience sampling. The World Health Organization Quality of Life for HIV （WHOQOL-HIV） BREF Chinese Version was used to measure the quality of life and the Memorial University of Newfoundland Scale of Happiness （MUNSH） was employed to measure subjective welfare. Qualitative interviews and focus group discussions were undertaken to learn about the palliative care provided and the specific needs of the end-of-life patients. Results Patients’ overall quality of life was moderate （12.62±1.97）. Highest scores were in the spirituality/religion/personal beliefs, higher than the average scores in the Chinese population （P0.01）, while psychological （13.58±2.06） and environment （12.50±3.28） domain scores were similar to the latter （P0.05）. Both independence （12.15±2.15） and physiological （14.04±3.16） domain scores were lower than the average of the people living with HIV/AIDS in other studies （P0.01）; however, all were in the moderate range. The average MUNSH score was 21.00±6.20, which was also moderate. The in-depth interviews indicated that the Henan Provincial Government’s policy of treatment and care had a beneficial impact on end-of-life AIDS patients, although the care components could be improved. Conclusions Living conditions of the end-of-life AIDS patients were moderate, and the HIV/AIDS palliative care model used was beneficial to them. Care could be improved by assisting the family unit as a whole.

Investigation on end-of-life electric and electronic equipment recycling and disposal system in China: legislation, education and dissemination

The Chinese obsolete electric and electronic equipments (EEE) recycling and disposal system on the point of view of legislation, education and dissemination were discussed, because of the highly increasing volume of electric and electronic products and that of its obsoletes today in China. The legislations and responsibilities of go- vernment, industry and consumer were discussed based on the balance of benefit and responsibility depending on the realization of their benefits in the whole life cycle of products and its status in the whole value chain. Not only the legislation and establishment of the so called “compulsory discarding system” will be a possible and effective solution to the difficulty of the obsolete collection and recycling for obsolete electric and electronic reclaiming industry, but also the education and dissemination. Education and dissemination were discussed as an important role which will emphasize the adjusting of policy and law on the development of electric and electronic industry production and its reclaiming. The education of stockholders’ environmental responsibility and the advocating of responsibility sharing should be implement for industry and consumer. Chinese EEE industry should emphasize the control of natural source, and should implement the environmental benign design in their production, such as design for dismantling, no dismantling, thermal treatment and green design. The perspectives for the way to advocate a harmonic society for Chinese people were described.

End-of-life vehicle recycling based on disassembly

The end-of-life vehicle recycling was studied based on the disassembly. The end-of-life recycling and the disassembly were reviewed and discussed. A disassembly experiment of an end-of-life engine was carried out, which strictly recorded the process of dismantling. Based on the results, a model of the end-of-life recycling was presented. In this model, the end-of-life parts were classified by three ways which included to recycle directly, to recycle after remanufacturing and to discard. By using this model, the dismantling efficiency and the recycling rate can be improved. Also, it obtains a good result after used in a dismantling factory.

End-of-life vehicles processing,towards a thermal treatment of auto shredder residue

All over the world,the management of End-of-life Vehicles(ELV) and Automobile Shredder Residue(ASR) is an increasing issue for the car industry.The setting up of several environmental directives,among others the notion of extended producer responsibility,encourage car manufacturers to find alternatives solutions to waste disposal.For 2017,China aims for the recyclability and energy recovery of 95% of total weight of used cars,and in order to reach this rate,the development of some ASR thermal processes could be envisaged.With this research,an overview of ELV management was given and the different solutions about ASR thermal treatment were presented.It is showed that in spite of its big heterogeneity,the high heating value of ASR makes pyrolysis and gasification very interesting,compared to incineration or disposal of in landfills.

A conceptual analysis of the meaning of comfort at the end-of-life using the Walker and Avant(2014)Framework

Objective:The aim of the authors is to clarify the concept of comfort at the end-of-life in order to support understandings of fundamental nursing care needed at this stage of healthcare.Methods:The Walker and Avant framework was applied to develop a deeper understanding of the concept of comfort at the end of life.Results:Five defining attributes of comfort in the end-of-life were identified and they are having a peaceful home-life environment,trust and consolation,proximity and social-cultural support,alleviation of suffering,and a process of integrated intervention by nurses.Conclusions:At the end-of-life patients commonly experience physical,psychological,social-cultural,and environmental discomfort.Patients’families also encounter significant challenges.However,their comfort needs are often secondary to that of the patient.Additionally,a lack of clarity exists regarding the holistic meaning of comfort at the end-of-life,which can largely be confined to understandings of physical comfort for the patient,with a limited understanding of addressing family/caregivers’needs.Therefore,this concept analysis may provide some guidance in this regard and also provides support toward a more integrated understanding of the concept.

Palliative Care, Suffering, Death Trajectory: A View of End-of-Life Care (EOL) Related Issues in Sub-Saharan Africa (SSA)

Palliative care in the sub-Saharan Africa (SSA) region despite some progress made since the first hospice was opened in Zimbabwe in 1979, still lags far behind that of countries with developed economies, and relatively suffers from not being wholly included into mainstream public health service delivery in SSA. The situation is made worse due to relatively poor and pervasive socio-politico-economic factors and the challenge of the changing and increasing non-communicable disease epidemiology in SSA countries. This situation results in a tension between scarce resources and service needs/provision which prevails in a good number of SSA countries. In large part the situation where palliative care, end of life and the death trajectory converge in SSA countries currently portrays one of scarcity of resources and suffering for those ill SSA patients who need the services. This article is an overview of the current situation as pertains to palliative care services in the SSA region and some of the factors that contribute to or perpetuate the current state of palliative care delivery in SSA countries.

Nurses towards End-of-Life Situations: Sympathy vs. Empathy

Background: Nurses providing end-of-life care play an important role in providing support to both the patient and his/her family during one of their most difficult time. Patients in this stage do not only require physical care but emotional support as well. Aside from being a care provider, nurses should be able to utilize their knowledge in therapeutic communication in order for the patients and his/her family members to verbalize their feelings and concerns. Objective: The purpose of this study is to identify whether nurses project sympathy or empathy while providing end-of-life care. It also aims to determine their lived experiences while proving care at this stage. Methodology: This study utilized the mixed convergent parallel design wherein both the quantitative research and qualitative research were employed. Result and Discussion: A factor analysis was conducted on 12 items with maximum likelihood extraction method and oblique (Promax) rotation method. The Kaiser-Meyer-Olkin (KMO) measure verified the sampling adequacy for the analysis, KMO = 0.792 (“meritorious” according to Kaiser (1974)). Bartlett’s Test of Sphericity (χ2 (66) = 1007.294, p α = 0.881, sympathy α = 0.804, and cognitive empathy α = 0.728). Correlations among the factors were r = 0.315 for affective empathy and sympathy, r = 0.295 for sympathy and cognitive empathy, and r = 0.356 for affective empathy and cognitive empathy. Emergent key themes and subthemes are based on participants’ responses. The key themes are heart-touching moments of nurses in providing end-of-life care, challenges encountered by nurses in providing end-of-life care and adaptive strategies used by nurses to the challenges they face in providing end-of-life care. Conclusion: Most nurses during end-of-life care express affective empathy, followed by sympathy and lastly cognitive empathy. Nurses are encouraged to show and practice affective and cognitive empathy rather than using sympathy in caring patient and dealing with family member in the end-of-life situations. Despite the challenges that nurses faced, they are able to provide quality care by utilizing several adaptive strategies such as listening and understanding, showing empathy, providing holistic care, being spiritual and being aware of the role as caregiver.

Decarbonization options of the iron and steelmaking industry based on a three-dimensional analysis

Decarbonization is a critical issue for peaking CO_(2) emissions of energy-intensive industries,such as the iron and steel industry.The decarbonization options of China’s ironmaking and steelmaking sector were discussed based on a systematic three-dimensional low-carbon analysis from the aspects of resource utilization(Y),energy utilization(Q),and energy cleanliness which is evaluated by a process general emission factor(PGEF)on all the related processes,including the current blast furnace(BF)-basic oxygen furnace(BOF)integrated process and the specific sub-processes,as well as the electric arc furnace(EAF)process,typical direct reduction(DR)process,and smelting reduction(SR)process.The study indicates that the three-dimensional aspects,particularly the energy structure,should be comprehensively considered to quantitatively evaluate the decarbonization road map based on novel technologies or processes.Promoting scrap utilization(improvement of Y)and the substitution of carbon-based energy(improvement of PGEF)in particular is critical.In terms of process scale,promoting the development of the scrap-based EAF or DR-EAF process is highly encouraged because of their lower PGEF.The three-dimensional method is expected to extend to other processes or industries,such as the cement production and thermal electricity generation industries.

Prediction and recovery of end-of-life vehicles of China

With the rapid development of automobile industry,car ownership of China continuously increases end-of-life vehicles(ELVs)as well.This paper analyzes the current situation of car production,car ownership and ELVs in China based on the data in the past ten years,also forecasts the number in a decade with the help of the grey system model GM(1,1)and the Matlab software.Then it reviews the recovery methods and modes of ELVs recycling.Then based on the problems existed in the ELVs recycling industry,it gives out some suggestions which are conductive to the development of ELVs recycling industry in China.

Nurses’ Experiences of Using the Liverpool Care Pathway Plan in Hospitalized Patients with Heart Failure in the End-of-Life Stage: A Qualitative Content Analysis

Background: The introduction of care pathway plans for end-of-life cares such as the Liverpool Care Pathway (LCP) reveals a unique possibility for inter professional collaboration. Knowledge of symptom relief and how to meet the patients’ needs at the last stage of the palliative phase are essential for the nurses’ approach and care actions, but the documentation of such implementations is still rare and sometimes criticized. Aim: To explore and describe nurses’ experiences of using the LCP plan with patients hospitalized with heart failure at the end-of-life stage. An explorative design was applied, using qualitative content analysis of 20 interviews with nurses practicing the LCP plan in two district hospitals in Norway. Results: The nurses found the LCP plan as quality assurance for treatment and care in patients with heart failure in the last hours and days of life. The use of the LCP plan implied: 1) individualized adjustment, 2) symptom relief and 3) a holistic approach. Conclusion: Nurses experienced that using the LCP plan as a comprehensive action plan contributed in the decision making process and improved inter professional communication. Using the LCP plan should be seen as a tool to practice individualized and holistic nursing to patients at the end-of-life and their families, as well as a purposeful relief of symptoms associated with heart failure.

Upside and downside correlated jump risk premia of currency options and expected returns

This research explores upside and downside jumps in the dynamic processes of three rates:domestic interest rates,foreign interest rates,and exchange rates.To fill the gap between the asymmetric jump in the currency market and the current models,a correlated asymmetric jump model is proposed to capture the co-movement of the correlated jump risks for the three rates and identify the correlated jump risk premia.The likelihood ratio test results show that the new model performs best in 1-,3-,6-,and 12-month maturities.The in-and out-of-sample test results indicate that the new model can capture more risk factors with relatively small pricing errors.Finally,the risk factors captured by the new model can explain the exchange rate fluctuations for various economic events.

Intelligent option portfolio model with perspective of shadow price and risk‑free profit

Since Markowitz proposed modern portfolio theory,portfolio optimization has been being a classic topic in financial engineering.Although it is generally accepted that options help to improve the market,there is still an improvement for the portrayal of their unique properties in portfolio problems.In this paper,an intelligent option portfolio model is developed that allows selling options contracts to earn option fees and considers the high leverage of options in the market.Deep learning methods are used to predict the forward price of the underlying asset,making the model smarter.It can find an optimal option portfolio that maximizes the final wealth among the call and put options with multiple strike prices.We use the duality theory to analyze the marginal contribution of initial assets,risk tolerance limit,and portfolio leverage limit for the final wealth.The leverage limit of the option portfolio has a significant impact on the return.To satisfy the investors with different risk preferences,we also give the conditions for the option portfolio to gain a risk-free return and replace the Conditional Value-at-Risk.Numerical experiments demonstrate that the intelligent option portfolio model obtains a satisfactory out-of-sample return,which is significantly positively correlated with the volatility of the underlying asset and negatively correlated with the forecast error of the forward price.The risk-free option model is effective in achieving the goal of no drawdown and gaining satisfactory returns.Investors can adjust the balance point between returns and risks according to their risk preference.