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 notio...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.展开更多
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 ...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.展开更多
This paper presents the effects of surface finish and treatment on the high cycle fatigue behaviour of vibrating cylinder block of a new two-stroke free piston engine at complex variable amplitude loading conditions u...This paper presents the effects of surface finish and treatment on the high cycle fatigue behaviour of vibrating cylinder block of a new two-stroke free piston engine at complex variable amplitude loading conditions using frequency response approach. Finite element modelling and frequency response analysis was conducted using finite element analysis software Package MSC.PATRAN/MSC.NASTRAN and fatigue life prediction was carried out using MSC.FATIGUE software. Based on the finite element results, different frequency response approach was applied to predict the cylinder block fatigue life. Results for different load histories and material combinations are also discussed. Results indicated great effects for all surface finish and treatment. It is concluded that polished and cast surface finish conditions give the highest and lowest cylinder block lives, respectively; and that Nitrided treatment leads to longest cylinder block life. The results were used to draw contour plots of fatigue life and damage in the worst or most damaging case.展开更多
Disassembly and recycling of E-waste creates a series of environmental problems. The selection of a technologically reliable, environmentally friendly, economically affordable and socially acceptable recycling technol...Disassembly and recycling of E-waste creates a series of environmental problems. The selection of a technologically reliable, environmentally friendly, economically affordable and socially acceptable recycling technology for E-waste is a significant question. This study establishes a Monte-Carlo mathematical model of cost minimization, given the constraints of environmentally sound handling of the e-waste, in the context of Crystal Ball risk assessment and evaluation software. By following the streams of the different treatment processes, which consist of various technologies including disassembly, recycling and disposal, the econom-ics of various possibilities were identified and the optimal recycling technology proposed. The key factors of the proposed scenarios were determined by using sensitivity analysis. The results of this study show that, for discarded refrigerators, the operating life span plays the key role. The model supports maintenance and resale of the short lived refrigerators. For the longer lived refrigerators material recycling is recommended by the model. Sensitivity analysis shows that purchase cost, plastic sale price, condenser sale price and disassembly costs are the main effects. This study provides a significant technical support for policy making in E-waste management.展开更多
Background: After more than a decade of the nursing profession contending that healthcare reform based almost exclusively on cost cutting was creating an array of serious ethical issues for nurses, healthcare organiza...Background: After more than a decade of the nursing profession contending that healthcare reform based almost exclusively on cost cutting was creating an array of serious ethical issues for nurses, healthcare organizations and other providers are now facing increasing demands primarily from payers to demonstrate improvement in both quality of care and patient experience along with continued cost reduction. Research Question: Have efforts by healthcare organizations to comply with these recently imposed requirements influenced the ethical environment faced by nurses and nurse leaders and if so, how? Materials and Methods: Data for assessing the current ethical environment was gathered with a close-ended survey mailed in October 2012 to a random sample of 3000 members of the American Organization of Nurse Executives. Results and Discussion: Statistical analysis of the data and comparison with the findings of a similar study conducted in 2000 indicated that along with five highly rated issues in the earlier study attributed largely to economic constraints imposed by healthcare organizations, the top-10 key ethical issues today included five issues primarily attributable to interprofessional conflict. Conclusion: Given the success of many ongoing efforts aimed at weakening these key sources of ethical conflict that have blocked many proposals to improve the quality of care, opportunities should arise for the nursing profession to more fully achieve its goals of improving the quality of care, safety and patient satisfaction and enhancing nurses’ work environments essential to that effort.展开更多
目的:对临终沟通障碍-家庭版量表(Difficulties in End of Life Discussions-Family Inventory,DEOLD-FI)进行汉化,检验其在癌症人群中的信效度。方法:获得原作者授权后根据量表引进原则对DEOLD-FI进行汉化。对315例癌症病人进行调查,...目的:对临终沟通障碍-家庭版量表(Difficulties in End of Life Discussions-Family Inventory,DEOLD-FI)进行汉化,检验其在癌症人群中的信效度。方法:获得原作者授权后根据量表引进原则对DEOLD-FI进行汉化。对315例癌症病人进行调查,检验量表的信效度。结果:中文版DEOLD-FI共提取情感负担、消极态度、家庭负担、死亡恐惧、沟通能力5个公因子,累计方差贡献率为64.772%。总量表的Cronbach’sα系数为0.897,分半信度为0.828,重测信度为0.938,各维度的Cronbach’sα系数均在0.85以上。结论:中文版DEOLD-FI具有较好的信效度,可用于评估国内癌症病人与家庭成员进行临终沟通的障碍程度。展开更多
Purpose:The relevance of the study is that today,there is no unanimous position on the right to euthanasia implementation.The European Court of Human Rights(ECtHR),in making its decision,relies on the national legisla...Purpose:The relevance of the study is that today,there is no unanimous position on the right to euthanasia implementation.The European Court of Human Rights(ECtHR),in making its decision,relies on the national legislation of the respective state,as there is no single decision on the right to euthanasia in the European space.Therefore,the aim of the article is to comprehensively study the phenomenon of euthanasia,elaborate the decisions of the ECtHR on euthanasia and related rights,and develop recommendations on the possibility of legalizing euthanasia in Ukraine and prospects for the right to die implementation.Methodology:The leading method of research of this issue is comparative and law,which allows to comprehensively consider the right to euthanasia and its positive and negative components and helps to establish trends in the implementation of the outlined phenomenon.Findings:The article analyzes the current state of international and domestic legislation of some states on the use of euthanasia,reveals the meaning of the term“euthanasia,”provides a classification of euthanasia,analyzes the decisions of the ECtHR,and presents examples of national legislation of states within which euthanasia is legalized,the peculiarities of euthanasia recognition in the world are analyzed,as well as the research on the possibility of euthanasia legalization in Ukraine is presented.Value:The materials of the article have practical value for all those interested in euthanasia and the realization of the right to die,as well as for practicing lawyers and judicial authorities.展开更多
目的了解开展安宁缓和医疗(hospice and palliative care,HPC)对生命末期老年病人医疗状况的影响。方法连续查阅2014~2021年我院老年医学科死亡病人的病历,记录一般情况、心肺复苏意愿、生命支持手段的应用及临终前抢救措施。根据开展HP...目的了解开展安宁缓和医疗(hospice and palliative care,HPC)对生命末期老年病人医疗状况的影响。方法连续查阅2014~2021年我院老年医学科死亡病人的病历,记录一般情况、心肺复苏意愿、生命支持手段的应用及临终前抢救措施。根据开展HPC教育及临床工作的时间(以2018年1月为界点),将病例分为2014~2017年、2018~2021年2组进行纵向研究;并对2018~2021年开展HPC期间的病人进行亚组分析。结果共纳入254例死亡病人:2014~2017年死亡131例,2018~2021年死亡123例。2组年龄、性别、入院时躯体功能状况、1年内住院次数、住院时间、死亡原因构成差异均无统计学意义(P>0.05)。2组口服药物数量、多重用药比例、呼吸机使用率、使用白蛋白情况差异有统计学意义(P<0.05)。2组选择临终前不行心肺复苏及心外按压的比例差异无统计学意义(P>0.05),电除颤、简易呼吸器、血管活性药物、呼吸兴奋剂使用率差异有统计学意义(P<0.05)。2020~2021年与2018~2019年相比,生命末期老年病人多重用药率(37.3%比51.4%,P<0.05)、临终前血管活性药物使用率(49.0%比77.8%,P<0.05)、呼吸兴奋剂使用率(15.7%比50.0%,P<0.05)进一步下降。结论对于老年生命末期病人,开展HPC能够减少部分生命支持手段的使用,降低临终前无效医疗的应用。展开更多
目的评价终末期肾病行高通量血透治疗的预后效果,为终末期肾病患者治疗工作提供参考。方法选择我院2018年8月至2019年6月期间收治治疗的终末期肾病患者,总计80例。结合血透治疗方案进行随机法分组,对照组、观察组例数一致,伦理委员会审...目的评价终末期肾病行高通量血透治疗的预后效果,为终末期肾病患者治疗工作提供参考。方法选择我院2018年8月至2019年6月期间收治治疗的终末期肾病患者,总计80例。结合血透治疗方案进行随机法分组,对照组、观察组例数一致,伦理委员会审核批准。对照组40例终末期肾病患者行低通量血透治疗,观察组40例终末期肾病患者行高通量血透治疗,比较两组患者的治疗情况,包括并发症发生情况、血清学指标、降压药使用频率以及生活质量状况,参考健康调查简表(The MOS Item Short from Health Survey,SF-36)评估。结果就并发症情况分析,观察组患者高甲状腺血症、肾性骨病等并发症发生率5.00%明显低于对照组(20.00%),P<0.05;就β_(2)-微球蛋白、血红蛋白、血磷以及甲状旁腺素相关指标水平比较,治疗后比较治疗前改善,观察组β_(2)-微球蛋白(41.02±6.60)mg/L、血磷(1.73±0.33)μmol/L、甲状旁腺素(248.02±10.02)μmol/L均低于对照组,血红蛋白(114.20±9.20)g/L高于对照组,P<0.05;就降压药使用频率分析,观察组降压药使用频率7.50%明显低于对照组的25.00%,P<0.05;就生活质量评分进行分析,观察组患者评分高于对照组,P<0.05。结论对比低通量血透治疗,高通量血透治疗终末期肾病的效果显著,利于缓解和改善症状体征,且安全性获得保障,提高了患者的生活质量。展开更多
文摘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.
文摘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.
基金Project (No. 03-02-02-0056 PR0025/04-03) supported by Ministry of Science, Technology and Innovation, Malaysia
文摘This paper presents the effects of surface finish and treatment on the high cycle fatigue behaviour of vibrating cylinder block of a new two-stroke free piston engine at complex variable amplitude loading conditions using frequency response approach. Finite element modelling and frequency response analysis was conducted using finite element analysis software Package MSC.PATRAN/MSC.NASTRAN and fatigue life prediction was carried out using MSC.FATIGUE software. Based on the finite element results, different frequency response approach was applied to predict the cylinder block fatigue life. Results for different load histories and material combinations are also discussed. Results indicated great effects for all surface finish and treatment. It is concluded that polished and cast surface finish conditions give the highest and lowest cylinder block lives, respectively; and that Nitrided treatment leads to longest cylinder block life. The results were used to draw contour plots of fatigue life and damage in the worst or most damaging case.
基金Projects 50574094 supported by the National Natural Science Foundation of ChinaCPEUKF06-11 by the Key Laboratory Open Project of Education Ministry of China200600242 by the Science and Technology Innovation Project of Xuzhou
文摘Disassembly and recycling of E-waste creates a series of environmental problems. The selection of a technologically reliable, environmentally friendly, economically affordable and socially acceptable recycling technology for E-waste is a significant question. This study establishes a Monte-Carlo mathematical model of cost minimization, given the constraints of environmentally sound handling of the e-waste, in the context of Crystal Ball risk assessment and evaluation software. By following the streams of the different treatment processes, which consist of various technologies including disassembly, recycling and disposal, the econom-ics of various possibilities were identified and the optimal recycling technology proposed. The key factors of the proposed scenarios were determined by using sensitivity analysis. The results of this study show that, for discarded refrigerators, the operating life span plays the key role. The model supports maintenance and resale of the short lived refrigerators. For the longer lived refrigerators material recycling is recommended by the model. Sensitivity analysis shows that purchase cost, plastic sale price, condenser sale price and disassembly costs are the main effects. This study provides a significant technical support for policy making in E-waste management.
文摘Background: After more than a decade of the nursing profession contending that healthcare reform based almost exclusively on cost cutting was creating an array of serious ethical issues for nurses, healthcare organizations and other providers are now facing increasing demands primarily from payers to demonstrate improvement in both quality of care and patient experience along with continued cost reduction. Research Question: Have efforts by healthcare organizations to comply with these recently imposed requirements influenced the ethical environment faced by nurses and nurse leaders and if so, how? Materials and Methods: Data for assessing the current ethical environment was gathered with a close-ended survey mailed in October 2012 to a random sample of 3000 members of the American Organization of Nurse Executives. Results and Discussion: Statistical analysis of the data and comparison with the findings of a similar study conducted in 2000 indicated that along with five highly rated issues in the earlier study attributed largely to economic constraints imposed by healthcare organizations, the top-10 key ethical issues today included five issues primarily attributable to interprofessional conflict. Conclusion: Given the success of many ongoing efforts aimed at weakening these key sources of ethical conflict that have blocked many proposals to improve the quality of care, opportunities should arise for the nursing profession to more fully achieve its goals of improving the quality of care, safety and patient satisfaction and enhancing nurses’ work environments essential to that effort.
文摘目的:对临终沟通障碍-家庭版量表(Difficulties in End of Life Discussions-Family Inventory,DEOLD-FI)进行汉化,检验其在癌症人群中的信效度。方法:获得原作者授权后根据量表引进原则对DEOLD-FI进行汉化。对315例癌症病人进行调查,检验量表的信效度。结果:中文版DEOLD-FI共提取情感负担、消极态度、家庭负担、死亡恐惧、沟通能力5个公因子,累计方差贡献率为64.772%。总量表的Cronbach’sα系数为0.897,分半信度为0.828,重测信度为0.938,各维度的Cronbach’sα系数均在0.85以上。结论:中文版DEOLD-FI具有较好的信效度,可用于评估国内癌症病人与家庭成员进行临终沟通的障碍程度。
文摘Purpose:The relevance of the study is that today,there is no unanimous position on the right to euthanasia implementation.The European Court of Human Rights(ECtHR),in making its decision,relies on the national legislation of the respective state,as there is no single decision on the right to euthanasia in the European space.Therefore,the aim of the article is to comprehensively study the phenomenon of euthanasia,elaborate the decisions of the ECtHR on euthanasia and related rights,and develop recommendations on the possibility of legalizing euthanasia in Ukraine and prospects for the right to die implementation.Methodology:The leading method of research of this issue is comparative and law,which allows to comprehensively consider the right to euthanasia and its positive and negative components and helps to establish trends in the implementation of the outlined phenomenon.Findings:The article analyzes the current state of international and domestic legislation of some states on the use of euthanasia,reveals the meaning of the term“euthanasia,”provides a classification of euthanasia,analyzes the decisions of the ECtHR,and presents examples of national legislation of states within which euthanasia is legalized,the peculiarities of euthanasia recognition in the world are analyzed,as well as the research on the possibility of euthanasia legalization in Ukraine is presented.Value:The materials of the article have practical value for all those interested in euthanasia and the realization of the right to die,as well as for practicing lawyers and judicial authorities.
文摘目的了解开展安宁缓和医疗(hospice and palliative care,HPC)对生命末期老年病人医疗状况的影响。方法连续查阅2014~2021年我院老年医学科死亡病人的病历,记录一般情况、心肺复苏意愿、生命支持手段的应用及临终前抢救措施。根据开展HPC教育及临床工作的时间(以2018年1月为界点),将病例分为2014~2017年、2018~2021年2组进行纵向研究;并对2018~2021年开展HPC期间的病人进行亚组分析。结果共纳入254例死亡病人:2014~2017年死亡131例,2018~2021年死亡123例。2组年龄、性别、入院时躯体功能状况、1年内住院次数、住院时间、死亡原因构成差异均无统计学意义(P>0.05)。2组口服药物数量、多重用药比例、呼吸机使用率、使用白蛋白情况差异有统计学意义(P<0.05)。2组选择临终前不行心肺复苏及心外按压的比例差异无统计学意义(P>0.05),电除颤、简易呼吸器、血管活性药物、呼吸兴奋剂使用率差异有统计学意义(P<0.05)。2020~2021年与2018~2019年相比,生命末期老年病人多重用药率(37.3%比51.4%,P<0.05)、临终前血管活性药物使用率(49.0%比77.8%,P<0.05)、呼吸兴奋剂使用率(15.7%比50.0%,P<0.05)进一步下降。结论对于老年生命末期病人,开展HPC能够减少部分生命支持手段的使用,降低临终前无效医疗的应用。
文摘目的评价终末期肾病行高通量血透治疗的预后效果,为终末期肾病患者治疗工作提供参考。方法选择我院2018年8月至2019年6月期间收治治疗的终末期肾病患者,总计80例。结合血透治疗方案进行随机法分组,对照组、观察组例数一致,伦理委员会审核批准。对照组40例终末期肾病患者行低通量血透治疗,观察组40例终末期肾病患者行高通量血透治疗,比较两组患者的治疗情况,包括并发症发生情况、血清学指标、降压药使用频率以及生活质量状况,参考健康调查简表(The MOS Item Short from Health Survey,SF-36)评估。结果就并发症情况分析,观察组患者高甲状腺血症、肾性骨病等并发症发生率5.00%明显低于对照组(20.00%),P<0.05;就β_(2)-微球蛋白、血红蛋白、血磷以及甲状旁腺素相关指标水平比较,治疗后比较治疗前改善,观察组β_(2)-微球蛋白(41.02±6.60)mg/L、血磷(1.73±0.33)μmol/L、甲状旁腺素(248.02±10.02)μmol/L均低于对照组,血红蛋白(114.20±9.20)g/L高于对照组,P<0.05;就降压药使用频率分析,观察组降压药使用频率7.50%明显低于对照组的25.00%,P<0.05;就生活质量评分进行分析,观察组患者评分高于对照组,P<0.05。结论对比低通量血透治疗,高通量血透治疗终末期肾病的效果显著,利于缓解和改善症状体征,且安全性获得保障,提高了患者的生活质量。
