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.

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.

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.

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.

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.

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.

Intrahepatic portal venous systems in adult patients with cavernous transformation of portal vein: Imaging features and a new classification

Background: Cavernous transformation of the portal vein(CTPV) due to portal vein obstruction is a rare vascular anomaly defined as the formation of multiple collateral vessels in the hepatic hilum. This study aimed to investigate the imaging features of intrahepatic portal vein in adult patients with CTPV and establish the relationship between the manifestations of intrahepatic portal vein and the progression of CTPV. Methods: We retrospectively analyzed 14 CTPV patients in Beijing Tsinghua Changgung Hospital. All patients underwent both direct portal venography(DPV) and computed tomography angiography(CTA) to reveal the manifestations of the portal venous system. The vessels measured included the left portal vein(LPV), right portal vein(RPV), main portal vein(MPV) and the portal vein bifurcation(PVB). Results: Nine males and 5 females, with a median age of 40.5 years, were included in the study. No significant difference was found in the diameters of the LPV or RPV measured by DPV and CTA. The visualization in terms of LPV, RPV and PVB measured by DPV was higher than that by CTA. There was a significant association between LPV/RPV and PVB/MPV in term of visibility revealed with DPV( P = 0.01), while this association was not observed with CTA. According to the imaging features of the portal vein measured by DPV, CTPV was classified into three categories to facilitate the diagnosis and treatment. Conclusions: DPV was more accurate than CTA for revealing the course of the intrahepatic portal vein in patients with CTPV. The classification of CTPV, that originated from the imaging features of the portal vein revealed by DPV, may provide a new perspective for the diagnosis and treatment of CTPV.

A particle-resolved heat-particle-fluid coupling model by DEM-IMB-LBM

Multifield coupling is frequently encountered and also an active area of research in geotechnical engineering.In this work,a particle-resolved direct numerical simulation(PR-DNS)technique is extended to simulate particle-fluid interaction problems involving heat transfer at the grain level.In this extended technique,an immersed moving boundary(IMB)scheme is used to couple the discrete element method(DEM)and lattice Boltzmann method(LBM),while a recently proposed Dirichlet-type thermal boundary condition is also adapted to account for heat transfer between fluid phase and solid particles.The resulting DEM-IBM-LBM model is robust to simulate moving curved boundaries with constant temperature in thermal flows.To facilitate the understanding and implementation of this coupled model for non-isothermal problems,a complete list is given for the conversion of relevant physical variables to lattice units.Then,benchmark tests,including a single-particle sedimentation and a two-particle drafting-kissing-tumbling(DKT)simulation with heat transfer,are carried out to validate the accuracy of our coupled technique.To further investigate the role of heat transfer in particle-laden flows,two multiple-particle problems with heat transfer are performed.Numerical examples demonstrate that the proposed coupling model is a promising high-resolution approach for simulating the heat-particle-fluid coupling at the grain level.

Physical and mechanical properties and microstructures of submarine soils in the Yellow Sea

In recent years,the exploration of seabed has been intensified,but the submarine soils of silt and sand in the Yellow Sea area have not been well investigated so far.In this study,the physical and mechanical properties of silt and sand from the Yellow Sea were measured using a direct shear apparatus and their microstructures were observed using a scanning electron microscope.The test results suggest that the shear strength of silt and sand increases linearly with the increase of normal stress.Based on the direct shear test,the scanning electron microscope was used to observe the section surface of sand.It is observed that the section surface becomes rough,with many“V”‐shaped cracks.Many particles appear on the surface of the silt structure and tend to be disintegrated.The X‐ray diffraction experiment reveals that the sand and silt have different compositions.The shear strength of sand is slightly greater than that of silt under high stress,which is related to the shape of soil particles and the mineral composition.These results can be a reference for further study of other soils in the Yellow Sea;meanwhile,they can serve as soil parameters for the stability and durability analyses of offshore infrastructure construction.

基于SCAR标记和DNA条形码技术的苍术基原鉴别研究

目的开发出能同时鉴别北苍术和关苍术的分子标记方法,并探究不同种质资源苍术的遗传进化关系。方法对不同地区北苍术Atractylodes chinensis(Bunge)Koidz及关苍术A.japonica Koidz.ex Kitam基因组DNA的差异片段进行测序,结合SRAP、ISSR、DAMD分子标记方法,优化PCR反应体系,筛选并转换成特异性标记,同时,采用条形码方法分析种间序列差异。结果通过SRAP、ISSR、DAMD三种分子标记方法的PCR扩增,共筛选出198对能稳定扩增且重现性好的引物,转换出7对能稳定、快速鉴别北苍术和关苍术的SCAR引物。条形码方法检测出北苍术ITS2序列长度为454 bp,关苍术ITS2序列长度为453 bp,与其他苍术属植物之间遗传距离较远。NJ树结果显示,北苍术、关苍术及其他苍术属植物均各自聚为一支,表现出良好的单系性。依据ITS2二级结构,4种苍术属植物在螺旋区的茎环数目、大小、位置均有明显差异,可以直观地进行区分。结论所开发的特异性SCAR标记为苍术属植物优良品种的筛选提供了新方法,DNA条形码能稳定、准确鉴别北苍术。

ENTIRE SOLUTIONS OF HIGHER ORDER DIFFERENTIAL EQUATIONS WITH ENTIRE COEFFICIENTS HAVING THE SAME ORDER

In this paper,we consider entire solutions of higher order homogeneous differential equations with the entire coefficients having the same order,and prove that the entire solutions are of infinite lower order.The properties on the radial distribution,the limit direction of the Julia set and the existence of a Baker wandering domain of the entire solutions are also discussed.

临床药师参与1例心力衰竭、心肌梗死合并房颤患者的药物治疗

目的梳理复杂治疗方案后的抗栓方案,重整抗栓药物和疗程,纠正不合理用药,促进合理用药。方法临床药师介入1例心力衰竭、多次因心肌梗死植入多枚支架,合并房颤,行射频消融和左心耳封堵患者的药物治疗,重整抗栓药物方案,并全程监控治疗药物,就不合理用药提出警示。结果患者明显好转,住院及出院随访期间未发生不良事件。结论临床药师的参与有助于精细化管理患者的药物治疗方案,并及时纠正不合理用药,更好的为患者服务。

Printability disparities in heterogeneous material combinations via laser directed energy deposition:a comparative study

Additive manufacturing provides achievability for the fabrication of bimetallic and multi-material structures;however,the material compatibility and bondability directly affect the parts’formability and final quality.It is essential to understand the underlying printability of different material combinations based on an adapted process.Here,the printability disparities of two common and attractive material combinations(nickel-and iron-based alloys)are evaluated at the macro and micro levels via laser directed energy deposition(DED).The deposition processes were captured using in situ high-speed imaging,and the dissimilarities in melt pool features and track morphology were quantitatively investigated within specific process windows.Moreover,the microstructure diversity of the tracks and blocks processed with varied material pairs was comparatively elaborated and,complemented with the informative multi-physics modeling,the presented non-uniformity in mechanical properties(microhardness)among the heterogeneous material pairs was rationalized.The differences in melt flow induced by the unlike thermophysical properties of the material pairs and the resulting element intermixing and localized re-alloying during solidification dominate the presented dissimilarity in printability among the material combinations.This work provides an in-depth understanding of the phenomenological differences in the deposition of dissimilar materials and aims to guide more reliable DED forming of bimetallic parts.

Ascertaining the influences of auxiliary qubits on the Einstein–Podolsky–Rosen steering and its directions

Einstein–Podolsky–Rosen(EPR) steering is an example of nontrivial quantum nonlocality and characteristic in the non-classical world.The directivity(or asymmetry) is a fascinating trait of EPR steering,and it is different from other quantum nonlocalities.Here,we consider the strategy in which two atoms compose a two-qubit X state,and the two atoms are owned by Alice and Bob,respectively.The atom of Alice suffers from a reservoir,and the atom of Bob couples with a bit flip channel.The influences of auxiliary qubits on EPR steering and its directions are revealed by means of the entropy uncertainty relation.The results indicate that EPR steering declines with growing time t when adding fewer auxiliary qubits.The EPR steering behaves as damped oscillation when introducing more auxiliary qubits in the strong coupling regime.In the weak coupling regime,the EPR steering monotonously decreases as t increases when coupling auxiliary qubits.The increases in auxiliary qubits are responsible for the fact that the steerability from Alice to Bob(or from Bob to Alice) can be more effectively revealed.Notably,the introductions of more auxiliary qubits can change the situation that steerability from Alice to Bob is certain to a situation in which steerability from Bob to Alice is certain.

Preventing brain aging by the artificial enforcement of the unfolded protein response:future directions

As the life expectancy of the world’s population increases,age-related diseases are emerging as one of the greatest problems facing modern society.The onset of dementia and neurodegenerative diseases is strictly dependent on aging as a major risk factor and has a profound impact on various aspects of the lives of individuals and their families.

Effect of titanium on the sticking of pellets based on hydrogen metallurgy shaft furnace:Behavior analysis and mechanism evolution

Direct reduction based on hydrogen metallurgical gas-based shaft furnace is a promising technology for the efficient and low-carbon smelting of vanadium-titanium magnetite.However,in this process,the sticking of pellets occurs due to the aggregation of metal-lic iron between the contact surfaces of adjacent pellets and has a serious negative effect on the continuous operation.This paper presents a detailed experimental study of the effect of TiO2 on the sticking behavior of pellets during direct reduction under different conditions.Results showed that the sticking index(SI)decreased linearly with the increasing TiO2 addition.This phenomenon can be attributed to the increase in unreduced FeTiO3 during reduction,leading to a decrease in the number and strength of metallic iron interconnections at the sticking interface.When the TiO2 addition amount was raised from 0 to 15wt%at 1100°C,the SI also increased from 0.71%to 59.91%.The connection of the slag phase could be attributed to the sticking at a low reduction temperature,corresponding to the low sticking strength.Moreover,the interconnection of metallic iron became the dominant factor,and the SI increased sharply with the increase in re-duction temperature.TiO2 had a greater effect on SI at a high reduction temperature than at a low reduction temperature.

Effect of long reaction distance on gas composition from organic-rich shale pyrolysis under high-temperature steam environment

When high-temperature steam is used as a medium to pyrolyze organic-rich shale,water steam not only acts as heat transfer but also participates in the chemical reaction of organic matter pyrolysis,thus affecting the generation law and release characteristics of gas products.In this study,based on a long-distance reaction system of organic-rich shale pyrolysis via steam injection,the effects of steam temperature and reaction distance on gas product composition are analyzed in depth and compared with other pyrolysis processes.The advantages of organic-rich shale pyrolysis via steam injection are then evaluated.The volume concentration of hydrogen in the gas product obtained via the steam injection pyrolysis of organic-rich shale is the highest,which is more than 60%.The hydrogen content increases as the reaction distance is extended;however,the rate of increase changes gradually.Increasing the reaction distance from 800 to 4000 mm increases the hydrogen content from 34.91%to 69.68%and from 63.13%to 78.61%when the steam temperature is 500°C and 555°C,respectively.However,the higher the heat injection temperature,the smaller the reaction distance required to form a high concentration hydrogen pyrolysis environment(hydrogen concentration>60%).When the steam pyrolysis temperature is increased from 500°C to 555°C,the reaction distance required to form a high concentration of hydrogen is reduced from 3800 to 800 mm.Compared with the direct retorting process,the volume concentration of hydrogen obtained from high-temperature steam pyrolysis of organic-rich shale is 8.82 and 10.72 times that of the commonly used Fushun and Kivite furnaces,respectively.The pyrolysis of organic-rich shale via steam injection is a pyrolysis process in a hydrogen-rich environment.

FL-Online:An x-ray crystallographic web-server for atomic-scale structure analysis of biomolecule

FL-Online(http://fanlab.ac.cn) is an out-of-box modern web service featuring a user-friendly interface and simplified parameters, providing academic users with access to a series of online programs for biomolecular crystallography, including SAPI-online, OASIS-online, C-IPCAS-online and a series of upcoming software releases. Meanwhile, it is a highly scalable and maintainable web application framework that provides a powerful and flexible solution for academic web development needs. All the codes are open-source under MIT licenses in GitHub.

Profiling Electronic and Phononic Band Structures of Semiconductors at Finite Temperatures: Methods and Applications

Semiconductor devices are often operated at elevated temperatures that are well above zero Kelvin,which is the temperature in most first-principles density functional calculations.Computational approaches to com-puting and understanding the properties of semiconductors at finite temperatures are thus in critical demand.In this review,we discuss the recent progress in computationally assessing the electronic and phononic band structures of semiconductors at finite temperatures.As an emerging semiconductor with particularly strong temperature-induced renormalization of the electronic and phononic band structures,halide perovskites are used as a representative example to demonstrate how computational advances may help to understand the band struc-tures at elevated temperatures.Finally,we briefly illustrate the remaining computational challenges and outlook promising research directions that may help to guide future research in this field.