Final Hours Research Articles

Claiming the Reality (of Loss): Some Remarks on the Screenplay, Novel and FilmKwiecień (April, 1961) by Witold Lesiewicz and Józef Hen

The article discusses the interrelationships between Józef Hen’s novel Kwiecień (April), his two unpublishedscreenplays based on it, and Witold Lesiewicz’s fi lm Kwiecień (April, 1961), a canonicalwork of the Polish film school. The key problem concerns the question of the sense of sendingsoldiers to fight in the final days of the war, when its final outcome is already determined. Whenwriting his novel and its screenplay versions, Józef Hen referred to his own experience in April1945, when he fought in the ranks of the Second Polish Army and personally witnessed the tragedyof the soldiers dying in the final hours of the war, when personal ambitions and attitudes of commanderstook precedence over a rational assessment of the situation at the front. Hen’s noveland its screenplay and fi lm versions can therefore be seen as attempts at claiming the realityof loss. This is one of the main themes of Józef Hen’s writing. In April it is reflected in the attitudesof the main characters, as shaped by various dimensions of loss.

Seeing is believing – The application of Three-Dimensional modelling technologies to reconstruct the final hours in the life of an ancient Egyptian Crocodile

The application of non-invasive radiography (X-ray and CT) to an ancient Egyptian crocodile mummy demonstrated a high level of corporeal preservation achieved through artificial embalming. Analysis revealed numerous anomalies within the abdomen of the crocodile which merited further investigation using digital three-dimensional modelling technologies. Improving the clarity of the CT scan data enabled the authors to identify the anomalies which included a metal fish hook and a small fish. Segmentation of the CT scan data enabled the virtual extraction of the hook from within the confines of the mummy and its replication, firstly in plastic and then in its original material, bronze.Through the scientific analysis of the mummy, the authors reconstruct the biological biography and life history attributes of the animal, and consider the human-animal relationships and religious beliefs behind its post-mortem preservation. The study explores the application of the 3D technologies applied to archaeological materials and the novel implementation of experimental techniques to reproduce the anomaly. The investigation provided the ability to enhance the study, interpretation and display of the mummy; a matter of particular relevance in the case of mummified remains where anomalies are not directly visible. The authors consider the improved accessibility to cultural artefacts made possible through the application of enhanced visualisation techniques in the heritage sector.

#1563 Family feedback survey on quality of dialysis withdrawal and end-of-life care on hemodialysis patients in an ICU – a single-center study from India

Abstract Background and Aims End-of-life care in hemodialysis is emerging, with limited implementation in developing countries. There is a sparsity of data on dialysis withdrawal and the quality of end-of-life care in these regions. Developing countries differ in their cultural, social, and spiritual practice compared to the Western world and family plays a major role in decision-making. No survey has been done on family's perception of dialysis withdrawal and end-of-life care in our settings. So, we studied feedback from families regarding the quality of dialysis withdrawal and end-of-life care provided to maintenance hemodialysis (MHD) patients admitted to our intensive care unit (ICU). Method This study was conducted at Kasturba Medical College, Manipal, MAHE, Manipal, India between January 2020 to October 2022 involving the data from end-stage kidney disease (ESKD) patients on MHD admitted in the ICU, who had withdrawn from dialysis before death and received end-of-life care as per the hospital policy (Blue Maple) from Renal supportive and Palliative care team. The baseline data was collected for all patients and indications for withdrawal of dialysis and ICU treatment and end-of-life care provided were collected. The next of kin were interviewed by telephone by a single interviewer using a modified Quality of Death and Dying questionnaire. The data was analyzed using SPSS 20 Results Among 98 ESKD patients on maintenance hemodialysis who died in our ICU, 23 were referred to Palliative care, counselled, had withdrawal of dialysis at least 48 hours before death and received end-of-life care. Table 1 outlines baseline characteristics. The mean age was 57 ± 12.09 years, with a male predominance (82.6%). Common comorbidities included hypertension (100%), type 2 diabetes (69.5%), and ischemic heart disease (65.2%). The primary cause for ICU admission was infectious disease (47.8%). The majority of reasons for dialysis withdrawal and end-of-life care were worsening hemodynamic status (82.6%) and illness deterioration (69.5%). After consent and establishment of futility, dialysis withdrawal was done for all patients (100%), No CPR for 100%, withdrawal of inotropes in 50%, and withdrawal of ventilator was done in 80% of the patients. A successful telephonic interview/survey was conducted with 21 out of the 23 subjects, with the majority of next of kin being the spouse (47.6%) followed by children (33.3%) and siblings (14.3%). The questionnaire and response are given in Table 2. All expressed a need for palliative care involvement. 82% accepted the decision of dialysis withdrawal and end-of-life care put forth by the doctor's team without difficulty;74% of families were present with the patient in their final hours and were grateful for the same 20% had their spiritual leader to visit during the end-of-life event. None of the family members (100%) interviewed had a guilty feeling and all had a positive rating on the involvement of the palliative care team and the need to ease patients' distress and suffering during their final hours (100%). Unfortunately, none of the patients had prior discussions of advance care planning (ACP) with their doctors regarding end-of-life care before the specific event Conclusion Our study highlights that families agree with the withdrawal of artificial life support measures, such as MHD, CPR, withdrawal of inotropes, and/withdrawal of ventilator in ICU settings when these interventions are considered futile for end-of-life care in ESKD patients. It also emphasizes the need for ACP, and early integration of palliative care for discussions about dialysis withdrawal, and withholding futile interventions at end-of-life care in ESKD patients, especially in resource-constrained settings like ours, for high-quality end-of-life care. This will also lead to better end-of-life care outcomes and improved patient and family satisfaction with care.

Spatiotemporal Convolutional Approach for the Short-Term Forecast of Hourly Heavy Rainfall Probability Integrating Numerical Weather Predictions and Surface Observations

Abstract The accurate prediction of short-term rainfall, and in particular the forecast of hourly heavy rainfall (HHR) probability, remains challenging for numerical weather prediction (NWP) models. Here, we introduce a deep learning (DL) model, PredRNNv2-AWS, a convolutional recurrent neural network designed for deterministic short-term rainfall forecasting. This model integrates surface rainfall observations and atmospheric variables simulated by the Precision Weather Analysis and Forecasting System (PWAFS). Our DL model produces realistic hourly rainfall forecasts for the next 13 h. Quantitative evaluations show that the use of surface rainfall observations as one of the predictors achieves higher performance (threat score) with 263% and 186% relative improvements over NWP simulations for the first 3 h and the entire forecast hours, respectively, at a threshold of 5 mm h−1. Noting that the optical-flow method also performs well in the initial hours, its predictions quickly worsen in the final hours compared to other experiments. The machine learning model, LightGBM, is then integrated to classify HHR from the predicted hourly rainfall of PredRNNv2-AWS. The results show that PredRNNv2-AWS can better reflect actual HHR conditions compared with PredRNNv2 and PWAFS. A representative case demonstrates the superiority of PredRNNv2-AWS in predicting the evolution of the rainy system, which substantially improves the accuracy of the HHR prediction. A test case involving the extreme flood event in Zhengzhou exemplifies the generalizability of our proposed model. Our model offers a reliable framework to predict target variables that can be obtained from numerical simulations and observations, e.g., visibility, wind power, solar energy, and air pollution.

Transmedial Analysis of the Passion Narrative in the Scripture and the Movie the Passion of the Christ

Transmedia storytelling is the art of narrating stories using various media, with each medium adding something distinct to the narrative universe. This narrative universe may be accomplished with any media, including radio, TV, movies, video games, internet video, and web applications. The paper aims to demonstrate how different media platforms may convey one or more events over various channels to create a coherent whole. The article aims to comprehend the intricacies of translating written information into a visual medium using a cinematic approach. This study examines a trans-medial examination of two distinct transmedia storytelling approaches: the conventional methods of conveying the gospels in the Bible and the translation of the Gospels in the Scripture into a film. The two sources that were taken into consideration are the Four Gospels in the Holy Bible, which describes the final hours of Jesus’ life on Earth, and Mel Gibson’s film adaptation of those Gospels in the Scripture, The Passion of the Christ, which shows the events surrounding Christ’s conception, life, teachings, healings, temptation, and the crucifixion of Jesus Christ. Gibson opted for the transmedia medium of a movie to raise global awareness of Jesus’ sufferings in his last hours on Earth. This essay traces Gibson’s creative liberty by comparing his portrayal of The Passion of the Christ to the Biblical account of Jesus’ suffering in his final hours.

Exploring the needs and coping strategies of family caregivers taking care of dying patients at home: a field study

BackgroundMost Chinese patients chose to die at home, therefore there is a reliance on the family caregivers to be involved in their palliative care. The needs and coping strategies of family caregivers in home-based palliative care are rooted in culture. Little is known about the needs and coping strategies of family caregivers taking care of dying patients at home.MethodsA field study using semi-structured interview, participant observation, documents and records collection was employed. The study was conducted in two palliative care outpatient departments in tertiary hospitals and four communities in Beijing, China from March 2021 to July 2022. Using purposive sampling, twenty-five family caregivers were recruited. All collected data were analyzed using content analysis approach.ResultsFive themes emerged, including three care needs and two coping strategies. Family caregivers need to learn care skills and acquire care resources, including (i) decision-making about home-based palliative care, (ii) improving patient’s quality of life, and (iii) signs of final hours and funeral procedures. In facing the care burden, family caregivers coped by (iv) balancing the roles of caregivers and individuals: giving priority to patient care while maintaining their own normal life. In facing the death of a loved one, family caregivers responded by (v) making room for coming death by facing death indirectly and “rescuing” patients for consolation while preparing for the coming death.ConclusionFamily caregivers strive to balance the roles of being caregivers and being themselves. As caregivers, they actively prepare patients for good death with no regrets. As individuals, they preserve themselves from being hurt to maintain normal life. The needs of family caregivers focus on caregiver role and are manifested in care skills and resources.Trial registrationNot registered.

Can the addition of Interleukin-13 affect the cryosurvival of bovine embryos?

In this study, we investigated the impact of incorporating Interleukin-13 (IL-13) into the embryonic culture medium and its influence on cryotolerance and cellular viability of vitrified bovine embryos. Two distinct time points for IL-13 supplementation were explored: during the final hours of culture prior to cryopreservation and during the period of recultivation following cryopreservation and warming. Cryosurvival rates, total cell count, and cell viability were assessed using the TUNEL technique to determine the apoptotic percentage. Re-expansion and hatching rates did not show differences among all groups (P > 0.05), and the total cell number was comparable between the treated and control groups (P > 0.05). However, the group that received IL-13 before vitrification exhibited a higher apoptotic percentage (P < 0.05). This suggests that the anti-inflammatory effect of IL-13 may have impacted the embryo's defense capacity against the stress induced by cryopreservation, leading to an increased percentage of apoptosis, although it did not influence the developmental resumption capability.

A comparison of four dementia palliative care services using the RE-AIM framework

BackgroundLiving with a life-limiting illness, people with dementia benefit from palliative care which considers the holistic needs of the person and their family. However, little is known about how palliative care may be best provided to people living with dementia at home in the community. We examined four exemplary dementia palliative care services for people with dementia in the community, to see what activities they were providing, what were the commonalities and differences, and what lessons could be learned.MethodsA long-list of dementia palliative care services in Ireland, Northern Ireland, England, Scotland, and Wales, was identified through a survey, and four exemplar services were chosen based on criteria including: in operation >six months; provides identifiable activities; availability of routinely collected service data; not exclusively for people with dementia in final hours or days of life. Mixed-methods of data collection included interviews, focus-groups and surveys with service staff, surveys of service users, and routinely collected service data. The RE-AIM framework was used to describe and understand the sample of dementia palliative care services.ResultsThe four services had varied organisational structures and were led by different disciplines. However, they all provided common core activities including holistic and person-centred care, early advance care planning with service user involvement, carer support, integrated healthcare services, continuity of care, 24/7 support, bereavement support. All had needs-based referral criteria, accepting any age or dementia sub-type. All supported people with dementia to remain living at home and to have a comfortable, dignified death in their preferred place.ConclusionsAn effective dementia palliative care service may take different forms. Whether the service is dementia-led or Specialist Palliative Care-led, efficacy is associated with providing a range of key activities and implementing them effectively. The data collected strongly suggests the benefits of the dementia palliative care services to a person with dementia and their families and offers valuable insight into the key factors for the establishment and successful running of such services.

Journeying Apart: Exploring Informal Caregiver Experiences and Unmet Closures in Caring for COVID-19 Deceased.

The current study investigates the experiences and expectations of informal caregivers who lost their loved ones to the COVID-19 virus. The unusual circumstances of the deaths including physical isolation from their loved ones during the final hours before death significantly impacted their grieving process. In this interpretative phenomenological study, caregivers' experiences are explored through the lens of grief models and Gestalt perspectives. By thematic coding, seven superordinate themes emerged: Inability to accept death, Unfair nature of death, Helplessness, Regret and self-blame, Shattering of assumptive world, Using work as a distraction and Lack of government facilities. The findings of this study suggest that a significant number of informal caregivers continue suffering through the distress caused by the death of their loved ones in the pandemic, highlighting the need for grief counselling interventions for such bereaved informal caregivers.

Twenty-Two Years of GPS Monitoring at Rabaul Caldera, a Narrative History

It has long been recognised that volcanoes deform as fluids migrate, or change pressure in fractures and reservoirs within the volcano or in the crust below and around them. Calderas in particular have been shown to deform in complex and often major ways. The Rabaul Caldera is a type example of a caldera that undergoes complex and occasionally rapid deformation. This was first recognised by visual observations, and by the 1970s these movements were being monitored by traditional surveying techniques. Between 1972 and 1994, the centre of the caldera was uplifted by approximately 2 m. Following the 1994 eruption, it was indirectly found that parts of the caldera were uplifted ~6 m in the final hours before the eruption. It was realized that ‘real-time’ monitoring of the uplift may have given a better warning that an eruption was imminent. Traditional surveying techniques are time consuming; in the late 1990s, the only option for real-time monitoring was a Global Positioning System (GPS). By early 2000, a real-time GPS system was working at Rabaul Volcanological Observatory (RVO). Twenty-two years of continually recording differential GPS or Global Navigational Satellite System (GNSS) has proven the technique to be of immense importance. Often it has been the only parameter showing that unrest is happening. At times, inflation and deflation have warned of impending activity or recorded the emptying of the system; at other times, patterns of deformation have been more difficult to interpret. The technique has proven its worth in monitoring the status or general ‘health’ of the caldera, but for more precise forecasts it can only form part of an integrated monitoring system. Current testing of much cheaper receivers and improvements in telemetry mean the technique may soon be available for the more remote volcanoes of Papua New Guinea.

No One Should Die Alone: Preparing for the Next Pandemic

Introduction:As health care professionals and family members, we know that many patients died alone in healthcare settings during the first six months of the COVID-19 pandemic. An extensive literature review confirms this as well, and concludes that visiting restrictions during the pandemic had negative impacts on patients and their loved ones.There is a right to not die alone contained in the Dying Patient’s Bill of Rights; however, it happened time and time again during the early months of this pandemic when countless people in long-term care settings and hospitals were reported to be isolated during their final hours of life. No one should die alone! What can we learn from this experience to try to minimize this from happening during the next pandemic?Method:This study will explore the state of the literature on the status and impact of visitor restrictions during the COVID-19 pandemic, in conjunction with a survey of a defined sample of practicing registered nurses in the United States. This study seeks to respond to the primary research question of how patients’/family members’ end-of-life needs can be met in a pandemic when hospital visitation is severely limited or non-existent? There are for (4) related sub-questions concerning effective direct and indirect methods of family presence.Results:The literature concludes that countless people were isolated without family presence during their final hours of life during the first six months of COVID-19. The initial survey process is currently underway, with the identification and analysis of recommendations for improvement in early 2023.Conclusion:The goal of this study is to develop best practices for meeting the end-of-life needs of hospitalized patients and their loved ones during a pandemic, so that to the extent possible, no one dies alone.

Making the Case for the Great Dismal Swamp National Heritage Area: A Scoping Review

National Heritage Areas (NHAs) are nationally distinct landscapes that represent unique cultural, historical, and/or natural attributes significant to the legacy of the United States of America (U.S.). The Great Dismal Swamp, located in southeastern Virginia and northeastern North Carolina, is a prime candidate for NHA designation with diverse qualifications, among which was its antebellum role as a refuge for formerly enslaved people. The goal of our research, conducted in 2022 during the period of the U.S. Congressional debate on designation, was to investigate and expound upon the rationale for NHA designation of the Swamp. To do so, we used a scoping review to explore a sample of existing literature focused on the Great Dismal Swamp. We found significant evidence to support the Great Dismal Swamp NHA designation. Now, in its final hours of federal review and ratification, the Great Dismal Swamp will likely become America’s next NHA and continue its legacy as a place for nature-based and heritage tourism, inspiration, and reflection on the strength of humans to live and resist against even the most arduous of external forces. Further, our work serves to illustrate the range of unique factors that can support similar designations throughout the U.S. and internationally.

Preserving Soybean Oil for the Frying of Breaded Butterfly Shrimp Using Natural Rosemary Antioxidant.

Fried foods and frying oil are subjects that warrant the attention of researchers because of their high consumption. Indeed, frying conditions make these oils very sensitive to lipid oxidation which deteriorates the quality and nutritional properties of the food. In this study, we examined the effect of rosemary extract (ROE), known for its high antioxidant activity, in soybean oil used to fry breaded butterfly shrimp, by measuring the induction period with OXIPRES, total polar material (TPM), peroxide index (PI), and free fatty acids (FFA). This evaluation was performed in comparison with control oils without antioxidants. The results showed a significant difference between the oils according to the analyzed parameters, especially in the final hours of frying. The treatment of the oil with rosemary extract effectively delayed its oxidation, having lower levels in all the oxidation markers that were analyzed. It was also found that rosemary extract is able to reduce oil consumption by fried foods. Therefore, ROE ensures soybean oil a high stability against oxidation and a longer shelf life, making it a good natural alternative to synthetic antioxidants.

Relationship Between Palliative Care Consults and Outcomes of Pediatric Surgical Patients During Terminal Admissions.

Background: Pediatric patients often undergo surgery during terminal admissions. However, the involvement and timing of palliative care consults in caring for these patients has not been readily described. Objective: To describe the presence and timing of palliative care consults for pediatric patients who undergo surgical procedures during terminal admissions. Design: Retrospective cohort study using data from the electronic health record. Setting and Participants: Pediatric patients who underwent at least one surgical procedure during a terminal admission at an urban, quaternary hospital in the United States from January 1, 2016 to December 31, 2021. Main Outcomes and Measures: Patients' medical, surgical, and admission-level characteristics were abstracted. Associations were evaluated between these characteristics and the occurrence and timing of a palliative care consult relative to surgery and death. Results: Of 134 patients, 84% received a palliative care consult during their terminal admission. Approximately 36% of consults occurred before surgery, and 12% were within one day of death. Children without a palliative care consult were more likely than children with a consult to die during surgery (19.1% vs. 2.7%, p = 0.02), have surgery within 24 hours of death (52.4% vs. 15.9%, p < 0.001), and undergo a full resuscitation attempt (47.6% vs. 12.4%, p = 0.002). Receipt of a palliative care consultation did not differ by patient sex, reported race and ethnicity, language, insurance, or income level. Conclusions and Relevance: Palliative care consults support high-quality end-of-life care for children and impact perioperative outcomes, including intensity of surgical care and resuscitation in the final hours of life.

Comparison of the peaceful end of life theory with theory of human caring in clinical problem

This paper discusses two nursing theories, the "Peaceful End of Life Theory" and the "Theory of Human Caring," and their application in clinical practice. The "Peaceful End of Life Theory" focuses on improving the quality of life for terminally ill patients and achieving a peaceful end of life. Its major concepts include pain management, comfort, dignity, respect, being at peace, and closeness to significant others. The "Theory of Human Caring," emphasizes the importance of caring for both the patient and the nurse. It aims to improve nursing practice, education, management, and research. The theories are applied in clinical practice through interventions such as pain management, involving the family in decision-making, and ensuring a peaceful environment for the patient's final hours.

Biochemical alterations in the follicular fluid of bovine peri-ovulatory follicles and association with final oocyte maturation.

Follicular fluid (FF), a product of vascular transudate and granulosa and thecal cell secretions, is the milieu that has evolved to support oocyte growth and maturation which plays a central role in oocyte quality determination. Therefore, a suboptimal FF composition may be reflected in compromised oocyte progression through maturation, fertilization or embryo development. To date, the composition of bovine FF remains understudied. To address this, we comprehensively characterized the metabolomic constituency of bovine FF in the period during which the oocyte undergoes meiotic maturation. More specifically, FF from pre (-24 h) and peri (-2 h) -ovulatory follicles was profiled by high-throughput untargeted ultra-high-performance liquid chromatography tandem mass spectroscopy. A total of 634 metabolites were identified, comprising: lipids (37.1%), amino acids (30.0%), xenobiotics (11.5%), nucleotides (6.8%), carbohydrates (4.4%), cofactors and vitamins (4.4%), peptides (3.6%) and energy substrates (2.1%). The concentrations of 67 metabolites were significantly affected by stage of follicle development, 33.3% (n=21) were reduced (P≤0.05) by a mean of 9.0-fold, whereas 46 were elevated (P≤0.05) by a mean of 1.7-fold in peri vs. pre -ovulatory FF. The most pronounced individual metabolite concentration decreases were hypoxanthine (98.9-fold), xanthine (65.7-fold), 17β-oestradiol (12.4-fold), and inosine (4.6-fold). In contrast, the greatest increases were in retinal (4.9-fold), 1-methyl-5-imidazoleacetate (2.7-fold), and isovalerylcarnitine (2.7-fold). This global metabolomic analysis of bovine FF temporal dynamics provides new information for understanding the environment supporting oocyte maturation and facilitating ovulation, that has the potential for improving oocyte quality both in vivo and in vitro.

Verfehlungen und Strafen

Abstract This article compares the accounts of Pope Innocent IV’s death in Salimbene de Adam’s „Cronica“ and Matthew Paris’ „Chronica Majora“, focusing on the narrative strategies employed to ascribe a good or a bad death to the deceased through the depiction of his final hours. Each chronicler attributed different misdeeds to the pope, for which he was punished by his death. The results of this comparison suggest conclusions about the chroniclers and their works, the contemporary assessment of Pope Innocent IV, and descriptions of papal deaths in historiography.

Land–Atmosphere Interactions during GRAINEX: Planetary Boundary Layer Evolution in the Presence of Irrigation

Abstract This paper analyzed observations from the Great Plains Irrigation Experiment (GRAINEX) to better understand land–atmosphere (L–A) interactions and PBL evolution. This study is focused on a day when the largest forcing on the boundary layer originated from the land surface/land use. To examine these impacts, we also applied the Weather Research and Forecasting (WRF) Model. Results from the observations show that compared to nonirrigated areas, air temperature, wind speed, and PBL height (PBLH) were lower while dewpoint temperature and latent heat flux were higher over irrigated areas. Findings suggest that entrainment layer drying and differences in energy partitioning over irrigated and nonirrigated areas played an important role in PBL evolution. In the final hours of the day, the PBL collapsed faster over nonirrigated areas compared to irrigated. The WRF Model simulations agree with these observations. They also show that the extent of irrigation [expressed as irrigation fraction (IF)] in an area impacts L–A response. Under ∼60% IF, the latent heat flux and mixing ratio reach their highest value while temperature and PBLH are at their lowest, and sensible heat flux is near its lowest value. Results are reversed for ∼2% IF. It is concluded that irrigation notably impacts L–A interactions and PBL evolution.

“Don’t I Have a Say?”: A Critical Autoethnography on Choice and Essentiality-of-Being

In this autoethnography, I reflect on the last 72-hours of telephonic experiences with my godmother’s decision to live or die before entering a nursing facility. “Don’t I have a say” is a broader critical reflection about older adults’ lack of personal choices with regard to their health care without advance directives and the caregiver’s best interest decision-making approach. The central ideas in this autoethnography illuminate choice theory and the essentiality of being. From my godmother’s point of view, choice theory and essentiality of being highlight the need for her “owning” her health care decision. From my perspective, choice theory offers new perspectives and solutions to best interest decision-making as a potential caregiver. While in the final hours of my godmother’s life, she “owned” the decision; however, years later, I am still processing what happens when a person wills death to have the final say.

Dr Li Wenliang: Wuhan “Whistleblower” and Early COVID-19 Victim

Dr Li Wenliang: Wuhan “Whistleblower” and Early COVID-19 Victim