Search Results (362)

Context: Many patients at the end of life receive antibiotics to alleviate symptoms and improve quality of life; however, clear guidelines supporting decision making about the use of antibiotics are still lacking. Objectives: This study aimed to evaluate the benefits and harms of antibiotic use among patients under a palliative care community support team in Portugal. Methods: An observational, cross-sectional, retrospective study was conducted on 249 patients who died over a two-year period, having been followed for at least 30 days prior to their death. Data included patient demographics, clinical diagnoses, antibiotic prescriptions, and symptomatic outcomes. The effects of commonly prescribed antibiotics—amoxicillin + clavulanic acid, cefixime, ciprofloxacin, and levofloxacin—were compared using statistical analyses to assess survival, symptom intensity, and functional scales. Results: Adverse events, primarily infections and secretions, occurred in 57.8% of cases, with 33.7% receiving antibiotics. No significant difference in survival was observed across the antibiotic groups (p = 0.990). Symptom intensity significantly reduced after 72 h of treatment (p < 0.05), with ciprofloxacin demonstrating the greatest symptom control. The Palliative Outcome Scale decreased uniformly, with higher scores associated with amoxicillin + clavulanic acid (p = 0.004). The Palliative Performance Scale declined post-treatment, with significant changes noted for cefixime and ciprofloxacin (p < 0.05). Conclusions: Antibiotics may improve symptom control and quality of life in the end-of-life stage. While second-line antibiotics may offer additional benefits, the heterogeneity of the sample and limited adverse effect data underscore the need for further research to guide appropriate prescription practices in palliative care. Full article

Background: Lung cancer remains one of the leading causes of cancer-related mortality worldwide. While most diagnoses occur in outpatient settings, a subset of cases are incidentally identified during emergency department (ED) visits. The clinical characteristics and treatment decisions of these patients, particularly in relation to social background factors such as living situation and access to primary care, remain poorly understood. Methods: We conducted a retrospective study of patients diagnosed with malignancies in the ED of a single institution between April 2018 and December 2021. Patients diagnosed with lung cancer within 60 days of an ED visit were included. Data on demographics, disease status, treatment decisions, and background factors—including whether patients lived alone or had a primary care physician (PCP)—were extracted and analyzed. Results: Among 32,108 patients who visited the ED, 148 were diagnosed with malignancy within 60 days; 23 had lung cancer. Of these, 69.6% had metastatic disease at diagnosis, and 60.9% received active treatment (surgery or chemotherapy). No significant associations were observed between the extent of disease and either living arrangement or PCP status. However, the presence of a PCP was significantly associated with the selection of best supportive care (p = 0.023). No significant difference in treatment decisions was observed based on age (cutoff: 75 years). Conclusions: Although social background factors such as living alone were not significantly associated with cancer stage or treatment choice, the presence of a primary care physician was associated with a higher likelihood of best supportive care being selected. This may indicate that patients with an established PCP have more clearly defined care goals at the end of life. These findings suggest that primary care access may play a role in shaping end-of-life care preferences, highlighting the importance of personalized approaches in acute oncology care. Full article

Background/Objectives: End-of-life care is a vital part of nursing education that has been overlooked until recent years. Advance care planning should be incorporated into the prelicensure nursing curriculum to build student nurses’ confidence in aiding patients and families with their preferred future care plans. Advance care planning tools, such as the Advance Health Care Directive (AHCD) and Five Wishes, provide experiential learning opportunities that bridge theoretical knowledge with real-world patient advocacy. In this study, students were asked to complete either the AHCD or Five Wishes document as though planning for their own end-of-life care, encouraging personal reflection and professional insight. Embedding these assignments into nursing education strengthens students’ confidence in facilitating end-of-life discussions. This study applied Kolb’s experiential learning theory, including concrete experience, reflective observation, abstract conceptualization, and active experimentation, to explore student nurses’ perspectives on the Advance Health Care Directive and Five Wishes assignments, as well as their understanding of end-of-life care. Methods: This study used an exploratory–descriptive qualitative design featuring one open-ended question to collect students’ views on the assignments. Results: The final sample comprised 67 prelicensure student nurses from Bachelor of Science and Entry-Level Master’s programs. The Advance Health Care Directive and/or Five Wishes assignment enhanced students’ understanding of end-of-life decision-making. Conclusions: It is essential to complete the assignment and immerse oneself in an end-of-life situation to grasp patients’ perspectives and concerns regarding when to engage in difficult conversations with their patients. Full article

The aim of this study is to compare the environmental impact of composites reinforced with flax fiber technical embroidery and traditional woven fabric in order to provide conclusions supporting composite manufacturer management in making technology selection decisions. The research objectives are to identify the key stages in the life cycle of composites, from raw material acquisition to end-of-life; determine the environmental impact of each stage, with a particular focus on processes with the largest contribution to overall result; compare the environmental impact of embroidery-reinforced composites with traditional woven fabric-reinforced composites; propose strategies to minimize the negative environmental impact of composites, including modifying the component set and optimizing the production process. The method involves experimental research including the production of technical embroidery-based composites with varying stitch lengths and woven fabric-reinforced composites. The tensile strength of the composites was evaluated. Subsequently, life cycle assessment was conducted for each material according to the relevant ISO standards. The results presented in this paper provide a comprehensive assessment of the environmental performance of technical embroidery-reinforced composites and identify directions for future research in this field. Full article

Happiness is defined as well-being and contentment with life. The growing imperative to evaluate well-being beyond economic growth alone has led to the formulation of holistic indices that better reflect quality of life and sustainable development goals. This has resulted in the emergence of the Happiness Score (HS), which adopts a more holistic and human-centred perspective on development and well-being. The present study takes the Happiness Score as a basis for the identification of some of the main determinants of happiness in an empirical and data-driven perspective. To this end, data from 145 countries was analysed, using statistical methodologies such as Generalised Linear Models (GLM), Principal Component Analysis (PCA), fuzzy set Qualitative Comparison Analysis (fsQCA) and the decision tree machine learning approach. A range of indices were considered to translate the reality of countries in different socio-economic dimensions, the level of development of each country, and the continent to which it belongs. The African continent demonstrates substantial disparities across virtually all variables and is frequently associated with the most unfavourable values for each index. The indicators that exerted the most profound influence on happiness were identified as the freedom to make life choices, literacy rate, and Gross Domestic Product (GDP) per capita. These results inform policy strategies aligned with sustainable development, emphasising that enhancing happiness requires multidimensional action beyond economic indicators—particularly in low- and middle-income countries. Full article

The COVID-19 pandemic sparked changes globally, as leaders scrambled to protect wellbeing and safety. With many U.S. students sent away from their campuses, undergraduate students still grappled with the time-old question: “what will I do after college,” except during an unprecedented time in history rife with heightened career uncertainty. This qualitative study presents the results of a survey administered as part of a mind–body health project conducted in the wake of the pandemic, speaking directly to undergraduate college students’ health-related career aspirations. Two open-ended survey questions—(1) what is your intended career, and (2) how (if at all) has the COVID-19 pandemic changed your perspective about your future career—were administered with thematic analysis conducted. Qualitative analysis using hybrid data and theory-driven approaches revealed several themes around an increased desire to work within health-related fields, decreased desire to work in healthcare, non-medical to medical career shift, and additional undecidedness. Connecting theory to practice, Super’s Life-Space, Life-Span Career Theory and Krumboltz’s Social Learning Theory of Career Decision-Making guide practical implications and grander discussion around career development during periods of crisis. Full article

The Fourth Industrial Revolution and artificial intelligence (AI) technology are driving the transformation of the meat industry from mechanization and automation to intelligence and digitization. This paper provides a systematic review of key technological innovations in this field, including physical technologies (such as smart cutting precision improved to the millimeter level, pulse electric field sterilization efficiency exceeding 90%, ultrasonic-assisted marinating time reduced by 12 h, and ultra-high-pressure processing extending shelf life) and digital technologies (IoT real-time monitoring, blockchain-enhanced traceability transparency, and AI-optimized production decision-making). Additionally, it explores the potential of alternative meat production technologies (cell-cultured meat and 3D bioprinting) to disrupt traditional models. In application scenarios such as central kitchen efficiency improvements (e.g., food companies leveraging the “S2B2C” model to apply AI agents, supply chain management, and intelligent control systems, resulting in a 26.98% increase in overall profits), end-to-end temperature control in cold chain logistics (e.g., using multi-array sensors for real-time monitoring of meat spoilage), intelligent freshness recognition of products (based on deep learning or sensors), and personalized customization (e.g., 3D-printed customized nutritional meat products), these technologies have significantly improved production efficiency, product quality, and safety. However, large-scale application still faces key challenges, including high costs (such as the high investment in cell-cultured meat bioreactors), lack of standardization (such as the absence of unified standards for non-thermal technology parameters), and consumer acceptance (surveys indicate that approximately 41% of consumers are concerned about contracting illnesses from consuming cultured meat, and only 25% are willing to try it). These challenges constrain the economic viability and market promotion of the aforementioned technologies. Future efforts should focus on collaborative innovation to establish a truly intelligent and sustainable meat production system. Full article

Background/Objectives: The place where a person dies serves as an indicator of end-of-life care quality. This study aims to identify the congruence of place of death (POD) and the reasons behind decision-making among terminally ill cancer patients in East Asia. Methods: We conducted a prospective multicenter cohort study in palliative care units in Japan, Korea, and Taiwan. Data were collected by the responsible physicians during routine clinical practice. Sankey diagrams were applied to present changes in reasons for POD incongruence. Results: A total of 2638 participants from 37 palliative care units in the three countries were enrolled, and most of them died at PCUs (Japan: 95.7%, Korea: 94%, Taiwan: 82%, p < 0.05). The congruence rate of the preferred and actual POD among PCU inpatients ranged from 70% to 80%. Availability of end-of-life care is the most common reason for preferred and eventual PCU death (78.6%, 72.2%, and 52.1%, respectively, p < 0.05). However, 13–22% of patients admitted to PCUs still preferred to die at home, for which traditional culture (20.2%, 40.8%, and 82%, respectively, p < 0.05) or family influence (44.4%, 38.8%, and 51.7%, respectively, p > 0.05) are the main reasons. Cultural and environmental factors, such as influences from family members’ preferences in the three countries or the ownership of housing/housing settings in Japan, are the main challenges in achieving POD congruence. Conclusions: Culturally inclusive strategies in clinical practice and policy implementation for identifying the preferred POD, enhancing communication among stakeholders, and facilitating transitional support may improve the quality of goal-concordant care. Full article

Water, an essential asset for life and growth, is under growing pressure due to climate change, overpopulation, pollution, and industrialization. At the same time, water distribution within cities relies on piping networks that are over 30 years old and thereby prone to leaks, cracking, and losses. Taking this into account, non-revenue water (i.e., water that is distributed to homes and facilities but not returning revenues) is estimated at almost 50%. To this end, intelligent water management via computational advanced tools is required in order to optimize water usage, to mitigate losses, and, more importantly, to ensure sustainability. To address this issue, a case study was developed in this paper, following a step-by-step methodology for the city of Heraklion, Greece, in order to introduce an intelligent water management system that integrates advanced technologies into the aging water distribution infrastructure. The first step involved the digitalization of the network’s spatial data using geographic information systems (GIS), aiming at enhancing the accuracy and accessibility of water asset mapping. This methodology allowed for the creation of a framework that formed a “digital twin”, facilitating real-time analysis and effective water management. Digital twins were developed upon real-time data, validated models, or a combination of the above in order to accurately capture, simulate, and predict the operation of the real system/process, such as water distribution networks. The next step involved the incorporation of a hydraulic simulation and modeling tool that was able to analyze and calculate accurate water flow parameters (e.g., velocity, flowrate), pressure distributions, and potential inefficiencies within the network (e.g., loss of mass balance in/out of the district metered areas). This combination provided a comprehensive overview of the water system’s functionality, fostering decision-making and operational adjustments. Lastly, automatic meter reading (AMR) devices could then provide real-time data on water consumption and pressure throughout the network. These smart water meters enabled continuous monitoring and recording of anomaly detections and allowed for enhanced control over water distribution. All of the above were implemented and depicted in a web-based environment that allows users to detect water meters, check water consumption within specific time-periods, and perform real-time simulations of the implemented water network. Full article

As humans continue to develop the undersea engineering ecosystem of systems, the consequences of catastrophic events must continue to be investigated and understood. Almost every undersea pressure vessel, from pipelines to sensors to unmanned vehicles, has the potential to experience a catastrophic collapse, known as an implosion. This collapse can be caused by hydrostatic pressure or any combination of external loadings from natural disasters to pressure waves imparted by other implosion or explosion events. During an implosion, high-magnitude pressure waves can be emitted, which can cause adverse effects on surrounding structures, marine life, or even people. The imploding structure, known as an implodable volume, can be in a free-field or confined environment. Confined implosion is characterized by a surrounding structure that significantly affects the flow of fluid around the implodable volume. Often, the confining structure is cylindrical, with one closed end and one open end. This work seeks to understand the effect of fluid flow restriction on the physics of implosion inside a confining tube. To do so, a comprehensive experimental study is conducted using a unique experimental facility. Thin-walled aluminum cylinders are collapsed inside a confining tube within a large pressure vessel. High-speed photography and 3D Digital Image Correlation are used to gather structural displacement and velocities during the event while an array of dynamic pressure sensors capture the pressure data inside the confining tube. The results of this work show that by changing the size of the open end, referred to as the flow area ratio, there can be a significant effect on the structural deformations and implosion severity. It also reveals that only certain configurations of holes at the open end of the tube play a role in the dynamic pressure pulse measured at the closed end of the tube. By understanding the consequences of an implosion, designers can make decisions about where these pressure vessels should be in relation to other pressure vessels, critical infrastructure, marine life, or people. In the same way that engineers design for earthquakes and analyze the impact their structures have on the environment around them, contributors to the undersea engineering ecosystem should design with implosion in mind. Full article

Consumers’ growing interest in sustainability and the consideration of purchasing second-hand products present conditions for developing and improving a new method for Remaining Value (RV) estimation. The remaining value refers to the value of an end-of-life product that has been inspected, repaired, if necessary, and prepared for resale. Through the literature review, the main blockers, trustworthiness, price, and quality, were identified as preventing consumers from purchasing used products. Trustworthiness could be ensured by evaluating used products in an automated and model-based manner. To enhance consumers’ confidence, this study proposes a novel framework to assess the remaining value of non-new products by incorporating the diagnostic test results, even in the absence of a gold standard for model comparison and evaluation. This research expands the application of the Hui–Walter method beyond medical diagnostics by adapting it to sustainability-focused estimation. The proposed framework is designed to assist consumers in making data-informed purchase decisions and support retailers in assessing the market price while contributing to the environmental pillar of sustainability by reducing waste and resource consumption and extending the product lifetime. This work aligns with the United Nations Sustainable Development Goals 12 (Responsible Consumption and Production) and 13 (Climate Action) by providing quantifiable methods to extend the product lifecycle and minimize electronic waste. While this study focuses on developing the theoretical framework, future work will apply and validate this framework using empirical case studies and compare it with the remaining value estimation models. Full article

The reverse logistics of medical textiles has become a major concern in Morocco today, compelling authorities and professionals to develop a sustainable reverse logistics model. This study proposes a model for designing a sustainable closed-loop supply chain network in a fuzzy environment, using the medical textile life cycle as a case study. The model aims to generate economic gains, increase corporate social responsibility through job creation, and mitigate risks associated with the transportation of end-of-life products. In addition, the uncertainty of the model parameters is considered. The multi-objective model, formulated as a mixed-integer linear program, was solved using an exact approach, enabling strategic and tactical decision-making. Furthermore, the results demonstrate that accounting uncertainty can significantly impact strategic and tactical decisions in network design. Full article

The transition toward sustainability in the construction industry requires integrated tools that align with circular economy principles. This study introduces the Interactive Stakeholder Journey Map in Construction (ISJMC), an innovative visual and systemic tool that supports waste management and circularity throughout the life cycle of construction assets. Although the sector is economically significant, it remains one of the main contributors to environmental degradation due to high resource consumption and low waste recovery rates. Developed according to EN 15643-3:2012, a European standard that provides a framework for assessing the social sustainability of construction works, focusing on aspects such as accessibility, health, and comfort and grounded in the Design Thinking methodology, ISJMC enables mapping stakeholder interactions, touchpoints, and responsibilities across all life cycle stages, including initiative, design, procurement, construction, use, and end of life. A systematic literature review and collaborative workshops guided the tool’s development and validation. The application in a real case involving a medium-sized Brazilian construction company helped identify significant pain points and opportunities for implementing circular practices. The results demonstrate that ISJMC (i) facilitates a systemic and visual understanding of material and information flows, (ii) promotes transparent mapping of resource value to support better decision-making, and (iii) encourages the identification of circularity opportunities while fostering collaboration among stakeholders. The tool revealed critical challenges related to waste generation and management. It supported co-creating sustainable strategies, including improved material selection, lean construction practices, and stronger supplier engagement. By translating complex standards into accessible visual formats, ISJMC contributes to the academic field, supports practical applications, and offers a foundation for expanding circular approaches in construction projects. Full article

Applying circular economy principles to the renovation of existing buildings is increasingly recognized as essential to achieving Europe’s climate and energy goals. However, current decision-making frameworks rarely integrate life cycle carbon assessment with multi-criteria evaluation to support circular renovation strategies. This paper introduces an innovative framework that combines life cycle carbon assessment with multi-criteria decision analysis to identify and sequence circular renovation measures. The framework was applied to a residential case study in the Netherlands, using IES VE for operational carbon assessment and One Click LCA for embodied carbon assessment, with results evaluated using PROMETHEE multi-criteria analysis. Renovation measures were assessed based on operational and embodied carbon (including Module D), energy use intensity, cost, payback period, and disruption. The evaluation also introduced the embodied-to-operational carbon ratio (EOCR), a novel metric representing the proportion of embodied carbon, including Module D, relative to operational carbon savings over the building’s lifecycle. The homeowner’s preferences regarding these criteria were considered in determining the final ranking. The findings show that circular insulation options involving reused materials and designed for disassembly achieved the lowest embodied carbon emissions and lowest EOCR scores, with reused PIR achieving a 94% reduction compared to new PIR boards. The impact of including Module D on the ranking of renovation options varies based on the end-of-life scenario. The framework demonstrates how circular renovation benefits can be made more visible to decision-makers, promoting broader adoption. Full article

Background/Objectives: As dementia progresses, patients often lose decision-making capacity, leaving family members responsible for making critical end-of-life (EOL) care decisions. This cross-sectional descriptive study explored the factors associated with the intention to complete an advance directive (AD) among family caregivers of older adults with dementia in South Korea. Methods: This study surveyed 140 caregivers aged 20 years or older to assess their knowledge of advance directives (ADs), preferences for EOL care, and attitudes toward withdrawing life-sustaining treatment (LST). Data were collected from 1 August to 14 August 2024, and analyzed using descriptive statistics, the Chi-squared test, Fisher’s exact test, Spearman’s correlation, and logistic regression, with SPSS/WIN 28.0. Results: The intention to complete an AD significantly differed by religion (p = 0.004) and the functional status of the patient with dementia (p = 0.012). There was a positive correlation between intention to complete an AD and knowledge of ADs (r = 0.23, p = 0.007). Factors associated with intention to complete an AD included religion (OR = 4.36, p = 0.028) and knowledge of ADs (OR = 1.16, p = 0.033), explaining 22.2% of the variance, which is considered meaningful in studies dealing with complex psychosocial and behavioral variables. Conclusions: These findings suggest that religious affiliation and knowledge of ADs may contribute to greater emphasis on EOL preparedness and self-determination. To promote informed decision making, it is essential to implement targeted educational interventions—such as community-based workshops, telehealth counseling, and in-clinic guidance—that enhance caregivers’ understanding of ADs and empower them in their caregiving roles. Full article