End Of Life Research Articles

Factors associated with family decision-making self-efficacy among family members of patients with advanced cancer in mainland China.

In Chinese culture, family members are the main decision maker on end-of-life (EoL) issues for patients with advanced cancer. Yet little is known about Chinese families' confidence in making EoL decisions and its associated factors. This study aims to investigate the status and associated factors of Chinese family members' confidence in making EoL decisions for patients with advanced cancer. This cross-sectional study used a convenience sample of 147 family members of patients with stage III or stage IV cancer from a tertiary cancer center in Guangzhou, China. The questionnaires included demographic information of patients and their family members, patients' EoL preferences, and the Chinese version of the Family Decision-Making Self-Efficacy (FDMSE) Scale. A total of145 family members (98.64%) completed the questionnaires. The average score of FDMSE was 3.92 ± 0.53. A multiple regression analysis showed that the factors associated with FDMSE included patients' duration of disease, health insurance, participation in EoL decision-making, the expression of unfilled wishes, and family members' employment status. Chinese family members were not confident enough in making EoL decisions for patients with advanced cancer. It is recommended to develop cultural-tailored advanced care planning models to clarify patient preferences and to enhance the family members' self-efficacy in making EoL decisions with or for patients with advanced cancer.

The difficult discussion on the deactivation of implantable cardioverter devices at the end of life: a systematic review.

Implantable cardioverter defibrillators (ICDs) reliably prevent death due to life-threatening arrhythmias; this may become less relevant in people with more severe heart failure who are reaching the end of life (EOL). This review aimed to explore the ICD deactivation process and identify ethical issues, especially around the initiation of relevant discussions among professionals and patients. Available literature was reviewed using four electronic databases to identify issues that may deter healthcare professionals from having important deactivation discussions and to address considerations for ICD management prior to the EOL. The search resulted in the retainment of 12 studies. Three themes emerged from the data: barriers and facilitators, ethical considerations in clinical practice, and nurse's role. Lack of knowledge, which has been associated with cultural differences, has been found among the barriers, and interdisciplinary education and open communication appeared as facilitators. As clinicians' ethical considerations and fears emerged from the literature, nurses' special role has not been sufficiently supported. Complex care requires facilitation by multidisciplinary teams and education around the device's function regarding EOL issues. Establishing expert consensus statements on advance care planning might help define the distinct roles of each healthcare practitioner involved. Further research is needed in addressing the identified gaps.

Challenges and Perspectives for Direct Recycling of Electrode Scraps and End‐of‐Life Lithium‐ion Batteries

AbstractThe growing demand and production of lithium‐ion batteries (LIBs) have led to a critical concern regarding their resources and end‐of‐life management. Consequently, LIB recycling has emerged as a prominent topic in academia and in industries, driven by new worldwide governmental regulations and the increasing gap between the supply and demand of critical and strategic raw materials. Widely considered as a more sustainable and cheaper recycling method compared to pyrometallurgy and hydrometallurgy, direct recycling currently grabs the spotlight. This perspective provides insights and outlooks on the chemical and technological challenges of the innovative direct recycling approach for LIBs, addressing both the production scraps and batteries at their end‐of‐life (EOL). Technological advancements, changes in battery chemistry, along with the LIB market dynamics and collaborations between battery makers and recyclers, are key drivers of LIB waste recycling. While production scraps lend themselves well to direct recycling, EOL batteries encounter challenges in adopting this novel recycling technology. Besides, the need to assess novel direct recycling processes using Life Cycle Assessment (LCA) is also important for identifying eco‐design strategies and optimizing the processes, leading to a more sustainable energy storage system.

Life cycle assessment of electric kick scooters: consolidating environmental impact quantification and concluding climate-friendly use options

BackgroundThe environmental impact of electric scooters has been the subject of critical debate in the scientific community for the past 5 years. The data published so far are very inhomogeneous and partly methodologically incomplete. Most of the data available in the literature suffer from an average bias of 34%, because end-of-life (EOL) impacts have not been modelled, reported or specified. In addition, the average lifetime mileage of shared fleets of e-scooters, as they are operated in cities around the world, has recently turned out to be much lower than expected. This casts the scooters in an unfavourable light for the necessary mobility transition. Data on impact categories other than the global warming potential (GWP) are scarce. This paper aims to quantify the strengths and weaknesses of e-scooters in terms of their contribution to sustainable transport by more specifically defining and extending the life cycle assessment (LCA) modelling conditions: the modelling is based on two genuine material inventories obtained by dismantling two different e-scooters, one based on a traditional aluminium frame and another, for the first time, based on plastic material.ResultsThis study provides complete inventory data to facilitate further LCA modelling of electric kick scooters. The plastic scooter had a 26% lower lifetime GWP than the aluminium vehicle. A favourable choice of electric motor promises a further reduction in GWP. In addition to GWP, the scooter's life cycles were assessed across seven other impact categories and showed no critical environmental or health impacts compared to a passenger car. On the other hand, only the resource extraction impact revealed clear advantages for electric scooters compared to passenger cars.ConclusionsUnder certain conditions, scooters can still be an important element of the desired mobility transition. To assure a lifetime long enough is the crucial factor to make the electric scooter a favourable or even competitive vehicle in a future sustainable mobility system. A scooter mileage of more than 5400 km is required to achieve lower CO2eq/pkm emissions compared to passenger cars, which seems unlikely in today's standard use case of shared scooter fleets. In contrast, a widespread use of e-scooters as a commuting tool is modelled to be able to save 4% of greenhouse gas (GHG) emissions across the German mobility sector.

De-escalating treatments and transitioning care in a cardiac intensive care units network

Abstract Funding Acknowledgements None. Background Recent data (1) have shown that end-of-life (EOL) management of patients with acute decompensated heart failure (ADHF) in Cardiac Intensive Care Units (CICU) is aggressive, with late or no involvement of palliative care (PC) teams. Purpose To evaluate current PC and EOL practices in a contemporary multicenter registry of patients with ADHF who deteriorated to cardiogenic shock (CS). Methods A survey-based approach was used to collect data on PC and EOL management practices. We enrolled CS patients from 12 participating centers. A subset of 153 patients with ADHF-CS, enrolled between March 2020 and March 2023, was analyzed. We asked participating centers to report their practice regarding de-escalating treatments and transitioning care in the context of EOL, focusing on 1) discussion of implantable cardioverter defibrillator (ICD) deactivation with patients, 2) documentation of do-not-resuscitate (DNR) orders in the patient's medical record, and 3) documentation of advance directives in the patient's medical record. We also examined early PC team involvement and ICD deactivation as indicators of de-escalating treatments and transitional care in ADHF-CS. Results are presented as numbers and percentages (%) for categorical variables and medians (interquartile range, IQR) for continuous variables. Results Baseline characteristics of the population are shown in Table 1. Figure 1 describes the practices of the participating centers. DNR was routinely documented in the medical records in only 5 of 12 centers (41.7%). PC teams were involved in 21 of 153 enrolled ADHF-CS patients (13.7%). Of the 51 patients with an ICD, 17 died: 13 patients (76%) died in the hospital and 4 (24%) died within 6 months of discharge. ICD deactivation occurred in 6 of 17 deceased patients (35.3%). One patient had ICD deactivation supported by home PC services. Conclusions This study shows that the practice of de-escalating therapy, including ICD deactivation, is not routine in the participating centers. Our findings highlight the importance of integrating PC as a concurrent process with intensive care to effectively address the unmet needs of these patients and their families.

Service Provider Perspectives on Advance Care Planning Use in Rural Dementia Patients and Caregivers: A Qualitative Study

ABSTRACT Advanced care planning (ACP) utilization remains very limited in rural communities compared to urban areas. ACP earlier in the disease trajectory is particularly important for people with dementia (PWD) due to its progressive nature affecting their decision-making ability. Considering the well-documented benefits of ACP in improving the quality of end-of-life (EOL) care, the rural vs. urban disparity may indicate poorer EOL quality for rural PWD. This study aimed to explore barriers and current resources for ACP of PWD from the perspectives of health or social service providers serving rural communities. Using a qualitative approach, semi-structured face-to-face interviews were conducted with 11 health or social service professionals serving older adults and their caregivers in rural Alabama. Thematic analysis revealed three major barriers: (1) lack of knowledge, (2) psychosocial barriers, and (3) limited access to healthcare. Participants also showed misconception that a lawyer or a notary is required for ACP. Two themes arose in the participants’ recommendations to address the barriers: (1) providing ACP-relevant information and (2) addressing psychosocial stressors about ACP. This study highlighted an urgent need for social policy in ACP education for caregivers and service providers in rural settings.

Anticancer therapy at end-of-life: A retrospective cohort study.

A significant proportion of patients with incurable cancer receive systemic anticancer therapy (SACT) within their last 30 days of life (DOL). The treatment has questionable benefit, nevertheless is considered a quality indicator of end-of-life (EOL) care. This retrospective cohort study aims to investigate the rates and potential predictors of SACT and factors associated with SACT within the last 30 DOL. The study also evaluates the scope of Eastern Cooperative Oncology Group (ECOG) performance status and the modified Glasgow prognostic score (mGPS) as decision-making tools for oncologists. This review of medical records included 383 patients with non-curable cancer who died between July 2018 and December 2019. Descriptive statistics with Chi-squared tests and regression analysis were used to identify factors associated with SACT within the last 30 DOL. Fifty-seven (15%) patients received SACT within the last 30 DOL. SACT within 30 last DOL was associated with shorter time from diagnosis until death (median 234 days vs. 482, p = 0.008) and ECOG score < 3 30 days prior to death (p = 0.001). Patients receiving SACT during the last 30 DOL were more likely to be hospitalised and die in hospital. ECOG and mGPS score were stated at start last line of treatment only in 139 (51%) and 135 (49%) respectively. Those with short time since diagnosis tended to receive SACT more frequently the last 30 DOL. The use of mGPS as a decision-making tool is modest, and there is lack in documentation of performance status.

End-of-Life Care of Persons with Alzheimer's Disease and Other Dementias.

End-of-life (EOL) care has been a common option for patients with terminal medical conditions such as cancers. However, the utilization of EOL care in Alzheimer disease and other dementing conditions have become available relatively recently. As the end-stage dementia approaches, the clinicians and caregivers become faced with numerous clinical challenges-delirium, neuropbehavioral symptoms, the patient's inability to communicate pain and associated discomfort, food refusal, and so on. In addition to providing quality clinical care to the EOL patients, clinicians should pay special attention to their families, assuring that their loved ones will receive supportive measures to improve quality of life (QOL).

Second Life of Used Lithium-Ion Batteries from Electric Vehicles in the USA

This article focuses on the reuse and recycling of end-of-life (EOL) lithium-ion batteries (LIB) in the USA in the context of the rapidly growing electric vehicle (EV) market. Due to the recent increase in the enactment of both current and pending regulations concerning EV battery recycling, this work focuses on the recycling aspect for lithium-ion batteries rather than emphasizing the reuse of EOL batteries (although these practices have value and utility). A comparative analysis of various recycling methods is presented, including hydrometallurgy, pyrometallurgy, direct recycling, and froth flotation. The efficiency and commercial viability of these individual methods are highlighted. This article also emphasizes the practices and capabilities of leading companies, noting their current superior annual processing capacities. The transportation complexities of lithium-ion batteries are also discussed, noting that they are classified as hazardous materials and that stringent safety standards are needed for their handling. The study underscores the importance of recycling in mitigating environmental risks associated with EOL of LIBs and facilitates comparisons among the diverse recycling processes and capacities among key players in the industry.

Beyond life: Exploring hemodynamic patterns in postmortem mice brains.

We utilize Laser Speckle Contrast Imaging (LSCI) for visualizing cerebral blood flow in mice during and post-cardiac arrest. Analyzing LSCI images, we noted temporal blood flow variations across the brain surface for hours postmortem. Fast Fourier Transform (FFT) analysis depicted blood flow and microcirculation decay post-death. Continuous Wavelet Transform (CWT) identified potential cerebral hemodynamic synchronization patterns. Additionally, non-negative matrix factorization (NMF) with four components segmented LSCI images, revealing structural subcomponent alterations over time. This integrated approach of LSCI, FFT, CWT, and NMF offers a comprehensive tool for studying cerebral blood flow dynamics, metaphorically capturing the 'end of the tunnel' experience. Results showed primary postmortem hemodynamic activity in the olfactory bulbs, followed by blood microflow relocations between somatosensory and visual cortical regions via the superior sagittal sinus. This method opens new avenues for exploring these phenomena, potentially linking neuroscientific insights with mysteries surrounding consciousness and perception at life's end.

Material Flow Analysis and Occupational Exposure Assessment in Additive Manufacturing End-of-Life Material Management.

Additive manufacturing (AM) offers a variety of material manufacturing techniques for a wide range of applications across many industries. Most efforts at process optimization and exposure assessment for AM are centered around the manufacturing process. However, identifying the material allocation and potentially harmful exposures in end-of-life (EoL) management is equally crucial to mitigating environmental releases and occupational health impacts within the AM supply chain. This research tracks the allocation and potential releases of AM EoL materials within the US through a material flow analysis. Of the generated AM EoL materials, 58% are incinerated, 33% are landfilled, and 9% are recycled by weight. The generated data set was then used to examine the theoretical occupational hazards during AM EoL material management practices through generic exposure scenario assessment, highlighting the importance of ventilation and personal protective equipment at all stages of AM material management. This research identifies pollution sources, offering policymakers and stakeholders insights to shape pollution prevention and worker safety strategies within the US AM EoL management pathways.

Analysis of the Carbon Footprint of Academic Gowns: A Case Study of Thai University

The apparel industry has a significant impact on climate change due to the substantial amount of greenhouse gas (GHG) emissions. Academic gowns commonly used in Thailand may be a significant contributor to high GHG levels due to apparel consumption. The objective of this study was to quantify the carbon footprint (CF) of an academic gown for bachelor degree students worn during the commencement ceremony at a private Thai university. The evaluation complies with the national guidelines on Carbon Footprint of Product (CFP) established by the Thailand Greenhouse Gas Management Organization (TGO) in line with ISO 14067:2018 Greenhouse gases - Carbon footprint of products - Requirements and guidelines for quantification. Considering only a single impact category: climate change, GHG emissions were calculated for the entire product life cycle, including raw material acquisition, production process, distribution, use, and the end-of-life (EoL) treatment, and relevant transportation/delivery. Data in this study were collected from the entrepreneur producing academic gowns for rental purposes. The numerical results revealed that CFP of an academic gown with a length of 40 inches, weighing 1,284.30 g, is 42.7 kgCO2-eq over its entire life cycle with 39.71% contributing from use phase and EoL treatment. The stages of raw material acquisition, use phase and production process caused most of the emissions at 41.08%, 33.69% and 18.49%, respectively. The carbon footprint of this gown serves as an important baseline data to enhance design development and the production process for emission reductions.

Estimating the Costs of End-of-Life Care in Patients With Advanced Cancer From the Perspective of an Insurance Organization: A Cross-Sectional Study in Iran

ObjectivesCancers are significant medical conditions that contribute to the rising costs of healthcare systems and chronic diseases. This study aimed to estimate the average costs of medical services provided to patients with advanced cancers at the end of life (EOL). MethodsWe analyzed data from the Sata insurance claim database and the Health Information System of Baqiyatallah hospital in Iran. The study included all adult decedents who had advanced cancer without comorbidities, died between March 2020 and September 2020, and had a history of hospitalization in the hospital. We calculated the average total cost of healthcare services per patient during the EOL period, including both cancer-related and noncancer-related costs. ResultsA total of 220 patients met the inclusion criteria. The average duration of the EOL period for these patients was 178 days, with an average total cost of $8278 (SD $5698) for men and $9396 (SD $6593) for women. Cancer-related costs accounted for 64.42% of the total costs, including inpatient and outpatient services. Among these costs, hospitalization was the primary cost driver and had the greatest impact on EOL costs. This observation was supported by the multiple linear regression model, which suggested that hospitalization in the final days of life could potentially drive costs in these patients. Notably, no specialized palliative care was provided to the patients included in this study. ConclusionsThe results demonstrate that there is a significant rise in costs of care in patients receiving routine cancer care rather than optimized EOL care.

Utilization of Palliative Radiation in Pediatric Oncology Patients at End-of-Life (EOL) (RP214)

Utilization of Palliative Radiation in Pediatric Oncology Patients at End-of-Life (EOL) (RP214)

Review article: Evaluation and care of the critically ill patient with cirrhosis.

The increase in prevalence of liver disease globally will lead to a substantial incremental burden on intensive care requirements. While liver transplantation offers a potential life-saving intervention, not all patients are eligible due to limitations such as organ availability, resource constraints, ongoing sepsis or multiple organ failures. Consequently, the focus of critical care of patients with advanced and decompensated cirrhosis turns to liver-centric intensive care protocols, to mitigate the high mortality in such patients. Provide an updated and comprehensive understanding of cirrhosis management in critical care, and which includes emergency care, secondary organ failure management (mechanical ventilation, renal replacement therapy, haemodynamic support and intensive care nutrition), use of innovative liver support systems, infection control, liver transplantation and palliative and end-of life care. We conducted a structured bibliographic search on PubMed, sourcing articles published up to 31 March 2024, to cover topics addressed. We considered data from observational studies, recommendations of society guidelines, systematic reviews, and meta-analyses, randomised controlled trials, and incorporated our clinical expertise in liver critical care. Critical care management of the patient with cirrhosis has evolved over time while mortality remains high despite aggressive management with liver transplantation serving as a crucial but not universally available resource. Implementation of organ support therapies, intensive care protocols, nutrition, palliative care and end-of-life discussions and decisions are an integral part of critical care of the patient with cirrhosis. A multi-disciplinary approach towards critical care management is likely to yield better outcomes.

Differences in end-of-life care patterns between types of hospice used for cancer patients: a retrospective cohort study.

In response to the rapid aging population and increasing number of cancer patients, discussions on dignified end-of-life (EoL) decisions are active around the world. Therefore, this study aimed to identify the differences in EoL care patterns between types of hospice used for cancer patients. In this population-based cohort study, the Korean National Health Insurance Service cohort data containing all registered cancer patients who died between 2017 and 2021 were used. A total of 408,964 individuals were eligible for analysis. The variable of interest, the type of hospice used in the 6months before death, was classified as follows: (1) Non-hospice users; (2) Hospital-based hospice single users; (3) Home-based hospice single users; (4) Combined hospice users. The outcomes were set as patterns of care, including intense care and supportive care. To identify differences in care patterns between hospice types, a generalized linear model with zero-inflated negative binomial distribution was applied. Hospice enrollment was associated with less intense care and more supportive care near death. Notably, those who used combined hospice care had the lowest probability and frequency of receiving intense care (aOR: 0.18, 95% CI: 0.17-0.19, aRR: 0.47, 95% CI: 0.44-0.49), while home-based hospice single users had the highest probability and frequency of receiving supportive care (Prescription for narcotic analgesics, aOR: 2.95, 95% CI: 2.69-3.23, aRR: 1.45, 95% CI: 1.41-1.49; Mental health care, aOR: 3.40, 95% CI: 3.13-3.69, aRR: 1.35, 95% CI: 1.31-1.39). Our findings suggest that although intense care for life-sustaining decreases with hospice enrollment, QoL at the EoL actually improves with appropriate supportive care. This study is meaningful in that it not only offers valuable insight into hospice care for terminally ill patients, but also provides policy implications for the introduction of patient-centered community-based hospice services.

In-Hospital Death and End-of-Life Status Among Patients With Adult Congenital Heart Disease　- A Retrospective Study Using the JROAD-DPC Database in Japan.

The end-of-life (EOL) status, including age at death and treatment details, of patients with adult congenital heart disease (ACHD) remains unclear. This study investigated the EOL status of patients with ACHD using a nationwide Japanese database.Methods and Results: Data on the last hospitalization of 26,438 patients with ACHD aged ≥15 years, admitted between 2013 and 2017, were included. Disease complexity (simple, moderate, or great) was classified using International Classification of Diseases, 10th Revision codes. Of the 853 deaths, 831 patients with classifiable disease complexity were evaluated for EOL status. The median age at death of patients in the simple, moderate, and great disease complexity groups was 77.0, 66.5, and 39.0 years , respectively. The treatments administered before death to patients in the simple, moderate, and great complexity groups included cardiopulmonary resuscitation (30.1%, 35.7%, and 41.9%, respectively), percutaneous cardiopulmonary support (7.2%, 16.5%, and 16.3%, respectively), and mechanical ventilation (58.7%, 72.2%, and 75.6%, respectively). Overall, 70% of patients died outside of specialized facilities, with >25% dying after ≥31 days of hospitalization. Nationwide data showed that patients with ACHD with greater disease complexity died at a younger age and underwent more invasive treatments before death, with many dying after ≥1 month of hospitalization. Discussing EOL options with patients at the appropriate time is important, particularly for patients with greater disease complexity.

Cellulose nanocrystal filled synthetic rubber: Sustainable production, environmental assessment and end-of-life biodegradation by polyphagous pests

Plastic and rubber productions have reached staggering levels, leading to environmental concerns and accumulation of microplastics (MPs) rising in ecosystems. Rubber tires, a major source of MPs, pose further challenges due to excessive use of carbon black (CB) nanofillers in their manufacturing process, stresses on adding the element of sustainability to these products. This study emphasizes on the production of bio-based cellulose nanocrystals (CNC) filled synthetic rubber with sustainability assessment through life cycle assessment (LCA). It investigates the end-of-life (EOL) biodegradation potentials of rubber waste using a polyphagous pest, fall armyworm (FAW) (Spodoptera frugiperda). The results revealed that the production of CNC filled rubber demonstrate enhanced modulus compared to CB nanofillers, while requires substantial resource consumption, impacting abiotic resource depletion–fossil fuels (ADPf), freshwater ecotoxicity (CTUe), global warming potential (GWP), particulate matter (PM) and other impact categories. Emissions associated with CNC filled rubber during EOL phase are comparatively lower than CB, rendering CNC based rubbers a potentially viable choice from an environmental sustainability perspective. EOL pest biodegradation of CNC filled rubber showed negligible to no discernible physiological effects, potentially attributed to the presence of a diverse gut microbiota community in FAW (S. frugiperda). These findings highlight the relationship between physiochemical properties and CNC biodegradability in synthetic rubbers, aiding the development of sustainable EOL strategies for rubber waste management.

Assessing environmental trade-offs in packaging systems for infant formula delivery: A cradle-to-gate plus end-of-life life cycle assessment

An LCA study was conducted comparing three packaging systems to deliver infant formula, including primary (plastic, composite, and steel containers), secondary (corrugated box), and tertiary (pallet) levels, all manufactured and distributed in North America. The project goal involved quantifying each system's environmental footprint (EF), evaluating the effect of end-of-life (EoL) modeling in LCA results, and interpreting trade-offs among environmental impact indicators.The functional unit was defined as a packaging system delivering 1000 g of infant formula from cradle-to-gate, plus EoL. The three packages, including EoL, were modeled using SimaPro 9.3.03, with TRACI 2.1 V1.06 Midpoint being the primary impact assessment method. The LCA was performed according to ISO 14040/14044 standards. EoL models included the cut-off method, the 50/50 allocation, and the circular footprint formula (CFF). The stochastic multi-attribute analysis (SMAA) method was implemented to evaluate the trade-offs among the midpoint indicators.The primary package significantly contributed to the three systems in all the evaluated categories. Adjusting the EoL models influences the overall results when comparing the packaging systems' impacts. Contributions in each category vary slightly, with minimal changeover from the highest or lowest package footprints in EoL models. The SMAA ranking preference for all EoL methods indicates that the plastic container is preferred, having the lowest EF with >50 % probability.Environmental impacts of the packages involved trade-off discussion. With the initial EoL methodology (cut-off method), Package 1 (plastic) shows the highest impact in 4 of the 10 impact categories, Package 2 (composite) in 2 of the 10 categories, and Package 3 (steel) in the remaining 4 categories. With the 50/50 allocation and CFF EoL methodologies, different conclusions were reached about the impacts of each package; however, SMAA results found that ranking of the packages within EoL methodologies did not change the conclusions that the plastic package is preferred.

Effective End-of-Life Management of Assets in Organization by Snowflake Integration

To preserve device stability and security in today's industrial environment, vulnerabilities must be found and fixed. Asset managers face issues in managing End-of-Life (EOL) statuses, which are subject to constant change, and in traversing many data sources. It is challenging to have uniform view into important data without a centralized dashboard. We suggest putting in place a scraping method to collect data from various sources in order to overcome these issues. After the EOL data has been thoroughly verified and updated, the results will be shown on a consolidated, scalable, and dependable dashboard that easily links into the current systems. Advanced data slicing and dicing techniques will be used, utilizing Snowflake's capabilities, to handle enormous datasets efficiently. This all-encompassing strategy seeks to improve asset management procedures, strengthen device security, and offer useful information for defensible decision-making