Advance Directives Research Articles

Exploring the Field of Virtual Avatar: A Bibliometric and Content Analysis

The virtual avatar (VA) concept has gained significant attention since the introduction of virtual products. This study aims to investigate the present level of advancement and forthcoming research directions in the domain of VA while also constructing a conceptual framework for VA. A thorough examination of the VA field was carried out by integrating bibliometric and content analytic techniques. Eight hundred ninety-nine journal articles underwent descriptive bibliometric analysis using CiteSpace and VOSviewer software to construct and visualize synthetic networks. Two hundred forty-eight documents were selected for content analysis. VA is mostly focused on a few specific disciplines and journals prioritizing innovation. Conducting empirical investigations in many settings can enhance the research areas of Virtual Reality (VR), Augmented Reality (AR), and Extended Reality (XR), including improving algorithms, exploring accessibility usage, and examining public service applications. Alternative theoretical frameworks can provide novel insights and additional directions for the development of the VA field.

Biodegradation of Crystalline Chitin: A Review of Recent Advancement, Challenges, and Future Study Directions

Biodegradation of Crystalline Chitin: A Review of Recent Advancement, Challenges, and Future Study Directions

Optimalisasi Sumber Daya Alam untuk Meningkatkan Ekonomi Kota Medan

This research aims to evaluate the use of Medan City's natural potential as the main driver of the economy. As a country that has abundant natural wealth, Medan has a great opportunity to direct economic growth in a more advanced and sustainable direction. Through a qualitative approach, this research explores various literature sources, including data from BPS, scientific journals, and other related literature. These findings highlight that although various programs and policies have been implemented, optimal use of natural resources in Medan, especially in the Fisherman's Village area, is still far from expectations. This fact is reflected in the low income of traditional fishing communities which only reaches around Rp. 1,429,551 per month. Therefore, this research emphasizes the need for more effective strategies in managing natural resources so that they can have a significant positive impact on the economy in Medan City.

Exploration of Network Management Methods in Higher Vocational Computer Education

With the rapid development of information technology, higher vocational computer education is gradually turning to network management to meet the needs of the information age. This paper describes the importance of network management in higher vocational computer education. The analysis of the status quo of network management reveals the problems of lagging in management mode, the low application rate of computer networks, and the constraints of traditional teaching. In response to these problems, suggestions and discussions are put forward, including strengthening the construction of network infrastructure, improving the network management mechanism, etc., to promote education management towards a more advanced and flexible network direction.

A comprehensive evaluation of lightning location accuracy using a weighted gridding method

For the newly built very low-frequency long-range lightning location network (VLF-LLN) in China based on the equivalent propagation velocity method, we have evaluated the probability of deviation distance between the locations results and the reference points by using a weighted gridding method, and have drawn some conclusions. (1) By analyzing the effects of different numbers and configurations of stations on the location deviations, it is found that when the number of participating stations increase, the location deviation relatively decreases, and the numbers and configurations of participating stations has much more effect on the probability of location deviation of the lightning flashes outside the network than those in the network; (2) We statistically analyzed the location deviation for each grid of the network by using a weighted gridding method. The deviation probability using 11-station synchronization as a reference is similar to that for 13-station synchronization per grid. Assuming that the deviation distance is less than 3–5 km, the average location results are almost unchanged when the station number exceeds 7 or 8; (3) Comparing with the Advanced Direction and Time-of-Arrival Detecting network (ADTD), our VLF-LLN has an average deviation value of 3.47 km and a median value of 1.81 km for 63767 lightning flashes, and 90% samples have the location deviation less than 8 km and 54% have the location deviation less than 2 km.

Midcrisis Reassessment of Jehovah's Witness Advance Directive.

Midcrisis Reassessment of Jehovah's Witness Advance Directive.

My Holistic Data Share: A WEB3 Data Share Application: Extending Beyond Finance to Privacy-Protected Decentralized Share of Multi-Dimensional Data to Enhance Global Healthcare

Abstract WEB3.0 technologies on network architectures, distributed ledgers, and decentralized artificial intelligence represents a transformative shift in how data are handled, stored and shared. These innovations promise to significantly enhance consumer data privacy rights by addressing fundamental vulnerabilities associated with traditional centralized systems and self-custody wallets. Data breaches in traditional systems operated mainly by third parties are more common, resulting in significant data leaks because of centralized storage and excessive data movement, sometimes unnecessarily. Healthcare data breaches have been a growing concern globally. Several hospitals faced operational halts on account of the impact of ransomware on patient care and privacy. WEB3 Wallets are a vital component emerging as a significant force for global financial inclusion, especially in developing economies. They promote inclusion, reduce costs and empower individuals through self-custody. Though major improvements are needed in these wallets, their use is rising steadily. The global cryptocurrency user base is expected to reach over 500 million by 2025, with substantial growth in emerging markets, according to a report by Statista in 2023. This paper introduces a concept beyond cryptocurrencies and finance into everyday real-world use cases that need combinatorial access to a person’s holistic data, including financial and health records, genomic data, and advanced directives, among others, that need to be privacy protected and shared with specific actors identified for their roles in the WEB3 ecosystem through decentralized identifiers and non-fungible token badges identifying particular recipients. The author introduced the concept at ETHBoston in April 2024, won accolades for a primitive implementation using underlying threshold cryptography technologies, and enhanced it into a conceptual holistic data share application for global healthcare, as presented in this paper.

Ultrafast Laser Processing for High-Aspect-Ratio Structures.

Over the past few decades, remarkable breakthroughs and progress have been achieved in ultrafast laser processing technology. Notably, the remarkable high-aspect-ratio processing capabilities of ultrafast lasers have garnered significant attention to meet the stringent performance and structural requirements of materials in specific applications. Consequently, high-aspect-ratio microstructure processing relying on nonlinear effects constitutes an indispensable aspect of this field. In the paper, we review the new features and physical mechanisms underlying ultrafast laser processing technology. It delves into the principles and research achievements of ultrafast laser-based high-aspect-ratio microstructure processing, with a particular emphasis on two pivotal technologies: filamentation processing and Bessel-like beam processing. Furthermore, the current challenges and future prospects for achieving both high precision and high aspect ratios simultaneously are discussed, aiming to provide insights and directions for the further advancement of high-aspect-ratio processing.

Feasibility of Nurse-Facilitated Advance Care Planning Among Older Veterans in a Dialysis Unit and an Oncology Infusion Center.

Many veterans with serious illnesses, such as end-stage kidney disease requiring dialysis and advanced cancer requiring treatment infusions, must make complex decisions about their current and future medical care. Advance care planning (ACP) is a process where individuals identify, express, and communicate their personal values, life goals, and preferences for care. ACP may be feasible in chemotherapy infusion centers or chronic dialysis centers during patient treatment. We assessed the feasibility of a licensed vocational nurse (LVN) facilitator to help veterans review the PREPARE for Your Care program (www.prepareforyourcare.org) and complete an advance directive (AD) in an outpatient hemodialysis unit or a chemotherapy infusion center. PREPARE For Your Care is an evidence-based online program with written pamphlets and ADs that prepares patients to participate with clinicians in making medical decisions. We measured the time to complete a session and the level of assistance required from LVNs via LVN self-report. Self-reported ease-of-use, comfort, and helpfulness were assessed on a 10-point Likert scale from 1 (not at all) to 10 (very). Twenty-eight patients were enrolled (mean age ± SD: 67 ± 11 years); all (100%) completed PREPARE and the AD within 1 session. The mean completion time was 100 (±40) minutes. Most of the patients required considerable assistance from the LVN. The mean scores were 8.0 of 10 for ease-of-use (±2.3), 7.7 of 10 (±2.8) for comfort, and 8.2 of 10 (±2.3) for helpfulness. This pilot study demonstrates that using PREPARE as an ACP tool for veterans may be feasible for patients during hemodialysis and chemotherapy infusion. Patients required considerable assistance from the LVN to complete PREPARE. Hemodialysis and chemotherapy infusion are opportunities when patients have time and space to consider ACP.

Digital health interventions for cardiovascular disease: A review of recent developments

Digital healthcare is revolutionizing cardiovascular care by enhancing diagnostic accuracy, treatment precision, and patient management. This review highlights key advancements, including the integration of smartphones and tablets with echocardiogram transducers for remote diagnosis, particularly in underserved regions. Emerging technologies such as 3-D printing are expected to make cardiac valve replacements more affordable, while artificial intelligence (AI) is transforming diagnostic practices by improving image analysis and risk prediction. Wearable devices, equipped with sensors for monitoring heart rate, rhythm, and other vital signs, offer real-time data that aids in early detection and personalized treatment. Mobile health applications facilitate immediate cardiac care and long-term management by leveraging the portability of smartphones. The Internet of Things (IOT) further enhances cardiovascular care by enabling comprehensive, remote monitoring and efficient data management. Collectively, these innovations are not only advancing the accuracy and accessibility of cardiovascular diagnostics but also empowering patients through more personalized and proactive healthcare approaches. This review explores the impact of these technologies on improving cardiovascular health outcomes and highlights future directions for further advancements.

Language-Models-as-a-Service: Overview of a New Paradigm and its Challenges

Some of the most powerful language models currently are proprietary systems, accessible only via (typically restrictive) web or software programming interfaces. This is the LanguageModels-as-a-Service (LMaaS) paradigm. In contrast with scenarios where full model access is available, as in the case of open-source models, such closed-off language models present specific challenges for evaluating, benchmarking, and testing them. This paper has two goals: on the one hand, we delineate how the aforementioned challenges act as impediments to the accessibility, reproducibility, reliability, and trustworthiness of LMaaS. We systematically examine the issues that arise from a lack of information about language models for each of these four aspects. We conduct a detailed analysis of existing solutions, put forth a number of recommendations, and highlight directions for future advancements. On the other hand, it serves as a synthesized overview of the licences and capabilities of the most popular LMaaS.

Moral nexus of unmet needs and care in person-centred care for patients with advanced dementia in a multicultural society.

Patients with advanced dementia experience multifaceted vulnerabilities because of their diminished capacities for decision making. The dominant versions of person-centred care (PCC) emphasise patient preferences and autonomy, which often undermines a recognition of their distinct unfulfilled needs. Determining whether an individual autonomy conception of personhood applies to patients with advanced dementia is morally problematic from various theoretical perspectives and leads to the one-approach-fits-all problem when caring for this patient population. The availability of patients' advanced directives varies depending on their cultural backgrounds. The goal of the study is to argue that PCC, with a focus on relational autonomy, should be the first step for caring for patients with advanced dementia. The study engages in a critical exploration of inclusivity and diversity in ethical thinking within a framework of PCC and uses philosophical argumentation to assess the viability of a relational autonomy conception of PCC. By taking relationality seriously, especially in caring for patients with advanced dementia in a multicultural society, and by considering the moral nexus of unmet needs through the perspective of PCC, we can resolve the problem of one-approach-fits-all in dementia care.

Advance directives in palliative care: how do they affect patients’ hope?

Advance directives in palliative care: how do they affect patients’ hope?

D-allulose attenuated metaflammation by calming adipose tissue macrophages, boosting intestinal barrier, and modulating gut microbiota in HFD mice

Overnutrition triggers obesity and metabolic dysregulation, causing metaflammation. D-allulose, exhibits anti-obesity and hypoglycemic benefits. However, its involvement in metaflammation remains incompletely understood. In this study, high-fat diet-fed mice were supplemented with 300 mg/kg of D-allulose for 60 days. Levels of inflammation in various tissues, changes in intestinal barrier function, and gut microbiota composition, which serve as key markers of metaflammation, were analyzed. We foud that D-allulose significantly attenuated HFD-induced metaflammation, evidenced by a reduction in inflammation levels and in the activation of proinflammatory macrophages in adipose tissue. Additionally, D-allulose effectively restored impaired intestinal barrier function in HFD-fed mice by enhancing the expression of tight junction proteins, replenishing goblet cell populations, and modulating intestinal flora composition, which improved intestinal barrier integrity and contributed to the attenuation of metaflammation. Our findings highlight the potential of D-allulose in obesity and metaflammation management and provide new directions for future applications and advancements of D-allulose.

Large language models (LLMs): survey, technical frameworks, and future challenges

Artificial intelligence (AI) has significantly impacted various fields. Large language models (LLMs) like GPT-4, BARD, PaLM, Megatron-Turing NLG, Jurassic-1 Jumbo etc., have contributed to our understanding and application of AI in these domains, along with natural language processing (NLP) techniques. This work provides a comprehensive overview of LLMs in the context of language modeling, word embeddings, and deep learning. It examines the application of LLMs in diverse fields including text generation, vision-language models, personalized learning, biomedicine, and code generation. The paper offers a detailed introduction and background on LLMs, facilitating a clear understanding of their fundamental ideas and concepts. Key language modeling architectures are also discussed, alongside a survey of recent works employing LLM methods for various downstream tasks across different domains. Additionally, it assesses the limitations of current approaches and highlights the need for new methodologies and potential directions for significant advancements in this field.

Perspectives of healthcare providers on withdrawal of life-sustaining treatment and advanced directives for unresponsive wakefulness syndrome in China.

We performed the current research to describe healthcare providers' perspectives toward withdrawal of life-sustaining treatment (WLST) and advanced directive (AD) of patients with unresponsive wakefulness syndrome (UWS) and to identify influencing factors of their perspectives. Healthcare providers were recruited during a professional conference on disorders of consciousness (DoC). Participants completed self-administered questionnaires which included demographics, personal perspectives regarding WLST and the perception of ADs. A total of 230 Chinese healthcare providers (female: 69.7%) were included. Only a small proportion reported positive attitudes toward withdrawing artificial nutrition and hydration (35.2%), antibiotics (30.9%), and do-not-resuscitation orders (23.5%) in UWS patients. As for predictors' identification, religion was significantly associated with the positive attitude toward DNR order (p = 0.004). Moreover, although 47.4% of the participants had never heard of ADs before of conference, almost all of them would consider ADs (95.7%) thereafter, especially for non-neurologists (p = 0.033). The propensity to WLST for UWS in China is low and perspective on WLST is significantly associated with individual characteristics. The attitudes of healthcare providers toward integrating ADs in the decisional process are positive. Future research regarding ADs and their predictors should be carried out to improve the quality of end-of-life care of UWS in China.

Advance Directives Revisited (2002 vs. 2023): Are We Closer to Uniformity?

Advance directives (AD) are based on state-specific statutes that vary in structure, terminology, and options. This variability leads to inconsistent end-of-life (EOL) care for patients who have executed an AD in one state but fall ill in another state. This study revisits a 2002 article that identified considerable differences in ADs to determine whether ADs have become more uniform. ADs from all 50 states and the District of Columbia were examined to determine the frequency of document types and seven key issues. The results were = compared to the 2002 study using non-parametric approaches. Mean numbers of key issues were compared using t-tests and one-way ANOVA. Consistent with 2002, three states in 2023 provide statutes for Health Care Power of Attorney (HCPOA). However, states offering a combined HCPOA, and living will (LW), deemed an advance directive for health care (ADHC), increased from 13 to 30. Between both studies, Long Term Care increased significantly in LW and ADHC, while Artificial Sustenance significantly increased in LW. Despite the rising prevalence of Alzheimer's in the United States, only 10% of states included this issue in 2023. Despite evolving healthcare trends, minimal revisions have been made to ADs since 2002. This lack of uniformity can cause confusion regarding proper understanding of EOL wishes. The authors recommend that the Uniform Act for Advance Directives be revisited to promote greater uniformity in ADs and ensure that individuals' preferences are understood and respected across different states.

Care conundrum in the emergency department: The gap between clinician awareness and patient expectations surrounding advance directives.

Clinicians in the emergency department (ED) frequently encounter seriously ill patients at a time when advance directives may be pivotal in improved clinician decision-making. The objectives of this study were to identify the prevalence of advanced directives in ED patients, as well as patterns of advance care discussions between patients and providers. This study describes patients' perceptions and expectations of such serious illness discussions in an emergency care setting with the expectation of including patients as strategic members of the care team. Trained research assistants in two emergency departments surveyed patients over age 65, or their caregivers, from July 2016 to August 2018. Patients were verbally administered a standard survey tool related to advance directives and advance care planning. 497 out of 877 patients completed surveys (59.4%). 50% of patients reported having an advance care planning document. The large majority (92%) of patients with an advance directive had not been asked about it during their ED visit. When questioned about their personal preferences, 79% of patients thought emergency physicians should be aware of their wishes regarding life-sustaining treatments and end-of-life care. Paradoxically, only 38% expressed a desire to discuss advance care plans with an ED clinician. Older patients expect emergency clinicians to be aware of their care preferences, yet most are not asked about these care preferences in the ED. The large gap between patient preference and reality suggests the need for more targeted discussion by ED clinicians and translation of patient perspectives into system healthcare improvements. Future studies should explore barriers to advance care planning in the ED as well as patient preferences for these conversations to support a true healthcare learning system.

Engineered Antibodies as Cancer Radiotheranostics.

Radiotheranostics is a rapidly growing approach in personalized medicine, merging diagnostic imaging and targeted radiotherapy to allow for the precise detection and treatment of diseases, notably cancer. Radiolabeled antibodies have become indispensable tools in the field of cancer theranostics due to their high specificity and affinity for cancer-associated antigens, which allows for accurate targeting with minimal impact on surrounding healthy tissues, enhancing therapeutic efficacy while reducing side effects, immune-modulating ability, and versatility and flexibility in engineering and conjugation. However, there are inherent limitations in using antibodies as a platform for radiopharmaceuticals due to their natural activities within the immune system, large size preventing effective tumor penetration, and relatively long half-life with concerns for prolonged radioactivity exposure. Antibody engineering can solve these challenges while preserving the many advantages of the immunoglobulin framework. In this review, the goal is to give a general overview of antibody engineering and design for tumor radiotheranostics. Particularly, the four ways that antibody engineering is applied to enhance radioimmunoconjugates: pharmacokinetics optimization, site-specific bioconjugation, modulation of Fc interactions, and bispecific construct creation are discussed. The radionuclide choices for designed antibody radionuclide conjugates and conjugation techniques and future directions for antibody radionuclide conjugate innovation and advancement are also discussed.

A dual summit of power? Career movements and multilevel circulation in the Spanish executive elite

ABSTRACT Drawing from the literature on political ambition, this article examines whether politicians holding executive offices exhibit similar patterns of movement between different levels of government as parliamentary elites. It also tests the influence of various institutional and political variables typical of federal systems. Focusing on Spain, the study classifies career movements based on the initial position and the direction of advancement, analyzing their variations depending on the availability, accessibility, and attractiveness of the structure of opportunities. The article particularly aims to elucidate why certain regions are more advantaged to provide decision-makers with more opportunities to circulate across political layers. Our sample includes cabinet members (prime ministers and ministers) and regional chief executives in Spanish regions from 1980 to 2021. The findings suggest that the status of regions, the availability of parliamentary seats, and the regional party system, among other factors, contribute to understanding regional variations in opportunities for executive level-hoppers.