Assessment of a Multimodal Strategy for Information and Collection of Advance Directives in a Comprehensive Cancer Center:Description of the Study Protocol

Background:Information on the possibility of drawing up Advance Directives(AD)is a necessity,and represents a major medical,ethical,and legal challenge.The difficulties are numerous,both organizational and cultural,and this is also true in the context of oncology,where ADs(and more broadly,advanced palliative care)are of critical importance.As an eminently sensitive subject,dealing with ADs(and therefore with end-of-life issues)requires both societal and medical/health-care acculturation.An institutional approach has therefore been developed,to deploy information tools,training professionals,and formalize the collection of AD.Such an approach cannot be implemented without an assessment not only of its objective results but also above all of its psychological effects,on both users(patients,family caregivers)and professionals.Methods:This longitudinal study,based on a mixed-method,interdisciplinary approach,will assess the impact of this information dissemination on AD,in terms of both potential positive and negative effects,using validated measurement methods.Thus,this study follows the 5 criteria of the RE-AIM model,designed to analyze the interest and impact of a device intended for users of the healthcare system;we will use a mixed methodology,relying on both a quantitative component(counting the number of people benefiting from the scheme,and those requesting support in drawing up their DA...,administering questionnaires),as well as a qualitative component(focus groups)which will enable us to study the subjective experiences of users,their relatives and the professionals involved in the scheme.Results:The results of this study will make it possible to determine the effects of this system of assistance in the drafting of ADs,which is currently being promoted by the legislator,but which is struggling to be implemented.

Development and evaluation of the Directive and Nondirective Support Scale for Patients with Type 2 Diabetes

Objectives:This study aims to develop the Directive and Nondirective Support Scale for Patients with Type 2 Diabetes(DNSS-T2DM)to measure diabetes-specific support and patients’preference as well as evaluate the construct validity and reliability of the DNSS-T2DM.Methods:A cross-sectional study was conducted in Tongzhou District,Beijing,China from July to September 2015.A total of 474 participants who had been diagnosed as type 2 diabetes by physicians and completed the DNSS-T2DM were included.The original 11-item DNSS-T2DM contains five items on nondirective support(Items 1-5)and six items on directive support(Items 6-11).There were two parallel questions for each item with one to measure the preference for support(Preference part)and the other to measure the perception of support in reality(Reality part).The final DNSS-T2DM was determined based on the results of the exploratory factor analysis(EFA).The construct validity of the final DNSS-T2DM was evaluated by the confirmatory factor analysis(CFA).The reliability was evaluated by internal consistency with Cronbach’sαcoefficients.Results:A final 7-item DNSS-T2DM loaded on 2 factors with four items representing nondirective support and three items representing directive support was determined based on the EFA.The CFA indicated a satisfactory construct validity.The internal consistency of the 7-item DNSS-T2DM as well as the nondirective support items was satisfactory with Cronbach’sα≥7.00.70.Conclusions:Our study supported the validity and reliability of the 7-item DNSS-T2DM.Further studies on the application of the DNSS-T2DM in different settings and population are needed.

European legal framework related to underground mining and tunnelling concerning commission directive (EU) 2017/164, 31 January establishing a fourth list of indicative occupational exposure limit values

Directive(EU)2017/164 establishes a fourth list of indicative occupational exposure limit values(IOELVs)to protect workers from risks of exposure to hazardous chemicals.It states that in underground mining and tunnelling,Member States may benefit from a transitional period regarding IOELVs for nitrogen monoxide,nitrogen dioxide,and carbon monoxide,during which the existing established IOELVs may be applied.The European Advisory Committee on Health and Safety at Work questions the technical feasibility of the proposed IOELVs in underground mining(CO,NO and NO2)and tunnelling(NO and NO2).Challenges arise concerning the availability of measurement methodologies for compliance with proposed IOELVs(NO2)in underground mining and tunnelling environments.

The Effect of Educational Intervention regarding Advance Care Planning for Advance Directives

This study aimed to examine the effects of empowerment and education intervention to promote Advance Care Planning (ACP) for residents in a highly aged and depopulated region. The study utilized a single-group pre- and post-test design and was conducted in Osakikamijima, Hiroshima, Japan. The researchers and town officials together formed an ACP committee and created an intervention framework. An ACP workshop was held for the participants and a self-administered questionnaire was carried out before, immediately after, and 3 months after the workshop. A total of 125 residents participated in the workshop and 87 of them completed more than 80% of the questionnaire items, whose responses were analyzed as valid responses. The number of participants who completed the AD increased significantly three months after the workshop (p = 0.008). There was a slight increase in the frequency of consultation with the family, but no change was observed in terms of consultation with healthcare providers. The educational intervention in-creased the respondents’ awareness and knowledge of ACP but did not affect the autonomous decision-making process regarding end-of-life care. This strategic process of ACP empowered the residents’ awareness and attitude towards end-of-life care with an increased completion rate of AD. On the other hand, cognitive barriers remained toward communication and decision-making shared with healthcare providers. Insufficient consultation with family members also became evident. Therefore, a new intervention strategy which helps increase communication with healthcare providers needs to be formulated and guidelines for consultation with the family and others need to be prepared.

Habitats of Directive 92/431EEC in the National Park of Alta Murgia （Apulia-Southern Italy）： Threat, Action and Relationships with Plant Communities

The study reports the habitats of Directive 92/43/EEC in National Park of Alta Murgia （Apulia Region, southem Italy）. The habitats have been identified based on phytosociological analysis. New records are presented of rocky, meadow, woodlands and temporary ponds habitats, such as： Stipo bromoidis-Quercetum dalechampii （habitat： eastern white oak woods, 91AA＊）; Verbenion supinae （habitat： Mediterranean temporary ponds, 3170＊）; Campanulo versicoloris-Dianthion japigici （habitat： calcareous rocky slopes with chasmophytic vegetation, 8210）; Acino suaveolentis-Stipetum austroitalicae （habitat： eastern sub-mediterranean dry grasslands （Scorzoneretalia villosae）, 62A0）. Other information on their extension, major threat and suggestions of actions for their conservation are provided.

Advance Directives in the Context of Uncertain Prognosis for Residents of Nursing Homes

This report documents the findings of a mixed-methods study focused on the advanced directives of 182 residents of three LTC facilities in southern Ontario, Canada. Although almost all had a completed advance directive within 3 months of death, most did not have a palliative designation or directive until a few days before they died. Each facility’s written Progress Notes revealed staff members usually sought additional confirmation of care preferences from residents’ substitute decision-makers within a few days of the death. It was thus common for advance directives to change from a more interventionist approach to the least interventionist approach near death. This change indicates that the meaning and significance of advance care planning and resulting advance directives must be considered in light of the processes and temporal factors involved in their completion and use within this distinct population. The relational nature of advance care planning and concern about ageism as a factor for withholding or withdrawing life support for LTC residents are considered as possible explanatory factors. These findings and their implications are described in relation to end-of-life care policies and practices in LTC facilities.

Preliminary Considerations About the Transposition of Directive 2013/34/EU Into Italian Accounting System

With the Directive No. 2013/34/EU dated June 26, 2013, the Parliament and the European Council have decreed a new era for the financial statements of companies in the EU member countries. The introduction of the new directive aims to improve the coverage information of the accounting document and to begin a process of simplification of administrative burdens and standards for the preparation and publication of the financial statements. In Italy, the directive must be transposed by July 20, 2015 for which the associations of accountants are evaluating the specific contents of the new rules to make applications for Italian companies. Some of the new rules and above all part of the new structures of the schemes of the financial statements are quite different from the approaches currently in use for which very heated discussions are taking place.

Renewable Diesel Fuel from Processing of Vegetable Oil in Hydrotreatment Units: Theoretical Compliance with European Directive 2009/28/EC and Ongoing Projects in Spain

Oil hydrotreating units in refineries are aimed at reducing the sulfur content of fuels to accomplish standard par-ticular specifications. However, this process is currently one of the best available technologies to produce biofuels from vegetable oil in a refinery. Vegetable oils can be processed or co-processed in these units if several adaptations are performed, so some properties could be improved in comparison with conventional fuel such as density and cetane number. This study highlights the theoretical greenhouse gases (GHG) emissions (using a life cycle assessment–LCA-approach) of a hydrotreated vegetable oil (HVO) from bibliographical data. Results were compared with other biofuel production processes, such as those obtained by transesterification of vegetable oil (FAME, fatty acid methyl ester). It has also been included the comparison with conventional fossil diesel as a benchmark in order to assess the theoretical compliance with GHG savings proposed in European Directive 2009/28/EC. Finally, ongoing projects and future perspectives in Spain are mentioned.

Directives and references in selected coronavirus-motivated internet memes

The use of directives in communicating the nature of the pandemic and reference to social experiences were promoted using images on social media platforms.The images or memes are used to create awareness and reinforce the criteria for safety during the pandemic.Previous studies on internet memes have concentrated on humor generation,speaker-hearer shared knowledge,neologism,and multimodality among others,with insufficient attention paid to the use of directives and references in such coronavirus-motivated memes.This paper,therefore,examines how directives and references are employed in conveying expected social responsibilities through coronavirus-motivated internet memes in Nigeria and other socio-cultural contexts.For data,one hundred coronavirus-motivated memes were purposively selected from Facebook,and eight representative memes were subjected to pragmatic analysis using aspects of Jacob Mey’s(2001.Pragmatics:An introduction,2nd edn.USA:Blackwell Publishing)pragmatic acts theory to unearth insights from them.The paper observes that the various spheres of life that are relatable to an online audience help to express what the pandemic is about and enhance the meaning of the pandemic with the context of the use of the memes,giving clearer perspectives on the pandemic.Directives and references are useful tools for conveying social responsibilities to online audience.

Superdirective Circular Arrays of Electric and Huygens Dipole Elements

Uniform circular arrays(UCAs)provide both omnidirectional(360°)and directive(sector)coverage of the azimuthal plane.Superdirective versions with unidirectional,high front-to-back ratio(FTBR)properties could provide the radiated field char-acteristics being pursued for NextG wireless networks and their perceived applications.Typical UCA configurations–full,semi-circular,and sector–that radiate vertically-polarized(VP)fields and are composed of either omnidirectional electric dipole ele-ments or unidirectional Huygens dipole elements are analyzed first with conventional methods as reference cases.These omni-and uni-directional element configurations are then treated with several optimization techniques:the classic Rayleigh-quotient(RQ)method and its unidirectional-constrained version;the eigenbeam decomposition and synthesis(EBDS)technique used to design su-perdirective acoustic receiving arrays;and the Bessel-azimuthal multipole(BEAM)approach developed herein.Several arrays are identified as being superdirective with extremely high FTBR values.The performance characteristics of the arrays of unidirectional elements are demonstrated to be superior in general.Moreover,it is shown that larger radius arrays with RQ-specified excitation amplitudes are robust to changes in them whereas the outcomes of the corresponding small radius versions are not.On the other hand,the BEAM-optimized densely-packed small-radius superdirective arrays are quite tolerant to those variations while generating unidirectional pseudo-needle beams.

Smart Cellulose‑Based Janus Fabrics with Switchable Liquid Transportation for Personal Moisture and Thermal Management

The Janus fabrics designed for personal moisture/thermal regulation have garnered significant attention for their potential to enhance human comfort.However,the development of smart and dynamic fabrics capable of managing personal moisture/thermal comfort in response to changing external environments remains a challenge.Herein,a smart cellulose-based Janus fabric was designed to dynamically manage personal moisture/heat.The cotton fabric was grafted with N-isopropylacrylamide to construct a temperature-stimulated transport channel.Subsequently,hydrophobic ethyl cellulose and hydrophilic cellulose nanofiber were sprayed on the bottom and top sides of the fabric to obtain wettability gradient.The fabric exhibits anti-gravity directional liquid transportation from hydrophobic side to hydrophilic side,and can dynamically and continuously control the transportation time in a wide range of 3–66 s as the temperature increases from 10 to 40℃.This smart fabric can quickly dissipate heat at high temperatures,while at low temperatures,it can slow down the heat dissipation rate and prevent the human from becoming too cold.In addition,the fabric has UV shielding and photodynamic antibacterial properties through depositing graphitic carbon nitride nanosheets on the hydrophilic side.This smart fabric offers an innovative approach to maximizing personal comfort in environments with significant temperature variations.

The Sustainable Procedure Framework for Disaster Risk Management: Illustrated by the Case of the EU Floods Directive in Sweden

How can the concrete meaning of the ambiguous and theoretical concept of sustainable development(SD) be defined and implemented, without losing sight of its fundamental principles? This study introduces a theoretical framework that supports studies of SD implementation in the context of strategic disaster risk management, by defining what SD implies with regard to planning procedures. The framework is based on the procedural SD principles of participation and integration. It was originally developed for,and has shown great value in, the field of water resource management. In-depth interviews with senior risk management researchers indicate that the framework is also applicable to and valuable for disaster risk management studies.To illustrate the application of the framework, a study of the EU Floods Directive in Sweden is summarized with the framework as the basis for the analysis.

Discovering API Directives from API Specifications with Text Classification

Application programming interface(API)libraries are extensively used by developers.To correctly program with APIs and avoid bugs,developers shall pay attention to API directives,which illustrate the constraints of APIs.Unfortunately,API directives usually have diverse morphologies,making it time-consuming and error-prone for developers to discover all the relevant API directives.In this paper,we propose an approach leveraging text classification to discover API directives from API specifications.Specifically,given a set of training sentences in API specifications,our approach first characterizes each sentence by three groups of features.Then,to deal with the unequal distribution between API directives and non-directives,our approach employs an under-sampling strategy to split the imbalanced training set into several subsets and trains several classifiers.Given a new sentence in an API specification,our approach synthesizes the trained classifiers to predict whether it is an API directive.We have evaluated our approach over a publicly available annotated API directive corpus.The experimental results reveal that our approach achieves an F-measure value of up to 82.08%.In addition,our approach statistically outperforms the state-of-the-art approach by up to 29.67%in terms of F-measure.

THE REGISTRATION OF TCM PRODUCTS UNDER EU TRADITIONAL HERBAL MEDICINAL PRODUCT DIRECTIVE

The Traditional Herbal Medicinal Products Directive(THMPD)2004/24/EC is a regulatory process established to enable high quality herbal medicines to be registered as an OTC product,with medical claims(as allowed for OTC drugs)on the packaging and in the patient information leaflet.For those products which are eligible to be registered they must firstly,be only for mild and self-limiting ailments。

Progress,challenges,and prospects of spent lithium-ion batteries recycling:A review

The recycling and reutilization of spent lithium-ion batteries(LIBs)have become an important measure to alleviate problems like resource scarcity and environmental pollution.Although some progress has been made,battery recycling technology still faces challenges in terms of efficiency,effectiveness and environmental sustainability.This review aims to systematically review and analyze the current status of spent LIB recycling,and conduct a detailed comparison and evaluation of different recycling processes.In addition,this review introduces emerging recycling techniques,including deep eutectic solvents,molten salt roasting,and direct regeneration,with the intent of enhancing recycling efficiency and diminishing environmental repercussions.Furthermore,to increase the added value of recycled materials,this review proposes the concept of upgrading recycled materials into high value-added functional materials,such as catalysts,adsorbents,and graphene.Through life cycle assessment,the paper also explores the economic and environmental impacts of current battery recycling and highlights the importance that future recycling technologies should achieve a balance between recycling efficiency,economics and environmental benefits.Finally,this review outlines the opportunities and challenges of recycling key materials for next-generation batteries,and proposes relevant policy recommendations to promote the green and sustainable development of batteries,circular economy,and ecological civilization.

Cell reprogramming therapy for Parkinson’s disease

Parkinson’s disease is typically characterized by the progressive loss of dopaminergic neurons in the substantia nigra pars compacta.Many studies have been performed based on the supplementation of lost dopaminergic neurons to treat Parkinson’s disease.The initial strategy for cell replacement therapy used human fetal ventral midbrain and human embryonic stem cells to treat Parkinson’s disease,which could substantially alleviate the symptoms of Parkinson’s disease in clinical practice.However,ethical issues and tumor formation were limitations of its clinical application.Induced pluripotent stem cells can be acquired without sacrificing human embryos,which eliminates the huge ethical barriers of human stem cell therapy.Another widely considered neuronal regeneration strategy is to directly reprogram fibroblasts and astrocytes into neurons,without the need for intermediate proliferation states,thus avoiding issues of immune rejection and tumor formation.Both induced pluripotent stem cells and direct reprogramming of lineage cells have shown promising results in the treatment of Parkinson’s disease.However,there are also ethical concerns and the risk of tumor formation that need to be addressed.This review highlights the current application status of cell reprogramming in the treatment of Parkinson’s disease,focusing on the use of induced pluripotent stem cells in cell replacement therapy,including preclinical animal models and progress in clinical research.The review also discusses the advancements in direct reprogramming of lineage cells in the treatment of Parkinson’s disease,as well as the controversy surrounding in vivo reprogramming.These findings suggest that cell reprogramming may hold great promise as a potential strategy for treating Parkinson’s disease.

Anisotropic time-dependent behaviors of shale under direct shearing and associated empirical creep models

Understanding the anisotropic creep behaviors of shale under direct shearing is a challenging issue.In this context,we conducted shear-creep and steady-creep tests on shale with five bedding orientations (i.e.0°,30°,45°,60°,and 90°),under multiple levels of direct shearing for the first time.The results show that the anisotropic creep of shale exhibits a significant stress-dependent behavior.Under a low shear stress,the creep compliance of shale increases linearly with the logarithm of time at all bedding orientations,and the increase depends on the bedding orientation and creep time.Under high shear stress conditions,the creep compliance of shale is minimal when the bedding orientation is 0°,and the steady-creep rate of shale increases significantly with increasing bedding orientations of 30°,45°,60°,and 90°.The stress-strain values corresponding to the inception of the accelerated creep stage show an increasing and then decreasing trend with the bedding orientation.A semilogarithmic model that could reflect the stress dependence of the steady-creep rate while considering the hardening and damage process is proposed.The model minimizes the deviation of the calculated steady-state creep rate from the observed value and reveals the behavior of the bedding orientation's influence on the steady-creep rate.The applicability of the five classical empirical creep models is quantitatively evaluated.It shows that the logarithmic model can well explain the experimental creep strain and creep rate,and it can accurately predict long-term shear creep deformation.Based on an improved logarithmic model,the variations in creep parameters with shear stress and bedding orientations are discussed.With abovementioned findings,a mathematical method for constructing an anisotropic shear creep model of shale is proposed,which can characterize the nonlinear dependence of the anisotropic shear creep behavior of shale on the bedding orientation.

Review on laser directed energy deposited aluminum alloys

Lightweight aluminum(Al)alloys have been widely used in frontier fields like aerospace and automotive industries,which attracts great interest in additive manufacturing(AM)to process high-value Al parts.As a mainstream AM technique,laser-directed energy deposition(LDED)shows good scalability to meet the requirements for large-format component manufacturing and repair.However,LDED Al alloys are highly challenging due to their inherent poor printability(e.g.low laser absorption,high oxidation sensitivity and cracking tendency).To further promote the development of LDED high-performance Al alloys,this review offers a deep understanding of the challenges and strategies to improve printability in LDED Al alloys.The porosity,cracking,distortion,inclusions,element evaporation and resultant inferior mechanical properties(worse than laser powder bed fusion)are the key challenges in LDED Al alloys.Processing parameter optimizations,in-situ alloy design,reinforcing particle addition and field assistance are the efficient approaches to improving the printability and performance of LDED Al alloys.The underlying correlations between processes,alloy innovation,characteristic microstructures,and achievable performances in LDED Al alloys are discussed.The benchmark mechanical properties and primary strengthening mechanism of LDED Al alloys are summarized.This review aims to provide a critical and in-depth evaluation of current progress in LDED Al alloys.Future opportunities and perspectives in LDED high-performance Al alloys are also outlined.

Complication rates after direct anterior vs posterior approach for hip hemiarthroplasty in elderly individuals with femoral neck fractures

BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.

New direction for surgery:Super minimally invasive surgery

The top goal of modern medicine is treating disease without destroying organ structures and making patients as healthy as they were before their sickness.Minimally invasive surgery(MIS)has dominated the surgical realm because of its lesser invasiveness.However,changes in anatomical structures of the body and reconstruction of internal organs or different organs are common after traditional surgery or MIS,decreasing the quality of life of patients post-operation.Thus,I propose a new treatment mode,super MIS(SMIS),which is defined as“curing a disease or lesion which used to be treated by MIS while preserving the integrity of the organs”.In this study,I describe the origin,definition,operative channels,advantages,and future perspectives of SMIS.