Spirituality as an Essential Element of Person-Centered Care

Data demonstrate that the majority of patients with serious or chronic illness would like their clinicians to address their spirituality but that the majority of clinicians do not provide such care. Reasons cited include lack of training. Palliative Medicine, built on the biopsychosocial-spiritual model of care, has long recognized the critical role of spirituality in the care of patients with complex, serious, and chronic illness. There is mounting evidence that spiritual care is a fundamental component of all high-quality compassionate health care, and it is most effective when it is recognized and reflected in the attitudes and actions of both patients and health care providers. We conducted focus groups as a first step in the process to arrive at a consensus definition of “spiritual care.” A second step involved collecting and comparing frameworks and models that recognize that providers cannot be made compassionate simply through the imposition of rules; methods were needed to achieve behavior change. The study group developed and piloted curriculum to train health care providers. The created curricula covered the definitions of a spiritual care, self-awareness, cultural sensitivity, assessment, and skills. As part of ongoing curriculum development processes, training included evaluation tools to accompany skill development . Our work demonstrated the need for compassionate presence during encounters, for applying the spirituality in professional life; and for identifying ethical issues in inter-professional spiritual care. We concluded that it is feasible to train clinicians to address spirituality and provide holistic and patient-centered care in an effort to minimize suffering.

Spirituality Training as an Essential Element of Person-Centered Care

Palliative Medicine, built on the biopsychosocial-spiritual model of care, has long recognized the critical role of spirituality in the care of patients with complex, serious, and chronic illnesses. We conducted focus groups to arrive at a consensus definition of “spiritual care.” Additionally, we collected and compared frameworks and models that recognize that providers cannot be made compassionate simply through the imposition of rules; methods were needed to achieve behavior change. The created curricula covered the definitions of spiritual care, self-awareness, cultural sensitivity, assessment, and skills. As part of ongoing curriculum development processes, training included evaluation tools to accompany competency standards. Results demonstrated improvements in self- reported abilities to (a) establish appropriate boundaries with patients; (b) apply the concept of compassionate presence to clinical care; (c) understand the role of spirituality in professional life; (d) identify ethical issues in inter-professional spiritual care. Clinicians need to address patients’ spiritual needs.

Energy, Exergy, Exergoeconomic and Exergoenvironmental Impact Analyses and Optimization of Various Geothermal Power Cycle Configurations

Energy, exergy, and exergoeconomic evaluations of various geothermal configurations are reported. The main operational and economic parameters of the cycles are evaluated and compared. Multi-objective optimization of the cycles is conducted using the artificial bee colony algorithm. A sensitivity assessment is carried out on the effect of production well temperature variation on system performance from energy and economic perspectives. The results show that the flash-binary cycle has the highest thermal and exergy efficiencies, at 15.6% and 64.3%, respectively. The highest generated power cost and pay-back period are attributable to the simple organic Rankine cycle (ORC). Raising the well-temperature can increase the exergy destruction rate in all configurations. However, the electricity cost and pay-back period decrease. Based on the results, in all cases, the exergoenvironmental impact improvement factor decreases, and the temperature rises. The exergy destruction ratio and efficiency of all components for each configuration are calculated and compared. It is found that, at the optimum state, the exergy efficiencies of the simple organic Rankine cycle, single flash, double flash, and flash-binary cycles respectively are 14.7%, 14.4%, 12.6%, and 14.1% higher than their relevant base cases, while the pay-back periods are 10.6%, 1.5% 1.4%, and 0.6% lower than the base cases.

Sensitivity Assessment of Chemotherapeutic Agents for Ovarian Tumors Based on Test in Vitro Culture: A Blind Study

Background: Ovarian cancer is common malignant tumors but the survival rate has not been improved well for a long time. One of the important reasons is that the current clinical guidelines for treatment still do not solve the problem of patient heterogeneity and drug resistance, which are exactly the key factors affecting the efficacy of chemotherapy. In addition, there are limited research data that can help accurately identify patients' preferred drugs and combination regimen, which fails to meet the needs of individualized treatment. Methods：The objective was used the Hydrogel Embedded Histoculture Drug Sensitivity Test (HDST), to verified its accuracy in predicting the response to chemotherapy in ovarian tumors and evaluate the sensitivity of chemotherapy drugs. Tissue samples of 82 ovarian tumor patients were tested for HDST drug sensitivity and follow-up who were included in randomized study. The consistency of drug sensitivity results and clinical outcomes were analyzed through preliminary study to determine the feasibility of this technology, and then a comprehensive blind study was conducted to evaluate Drug sensitivity.Result: HDST in determining the efficacy of chemotherapy drugs were consistent with the actual clinical efficacy of patients (Kappa=0.535), and the sensitivity, specificity, AUC were 82.14%, 100.00%, 0.911. Single-drug resistance rates of TXL, DOC, CDDP, CBP, Lobaplatin, and VP-16 were 21.95%, 74.39%, 62.20% , 52.44%, 39.02%, 60.98%, respectively. Highest Secondary drug resistance rate of CBP was 44.44%, followed by CDDP and VP-16 (22.22%). TXL’s IR was significantly higher than DOC wherever the location, and Loplatin’s was higher than CDDP (P<0.05). TXL’s IR was higher than VP-16 in primary foci, but VP-16’s was not only higher than DOC, but also CDDP, and similar to the CBP and Lobaplatin in abdominal metastases(P<0.05).Conclusion: HDST can effectively predict the response to existing chemotherapy regimens as new tool to screen individualized treatment for patients. Paclitaxel combined with Lobaplatin regimen may have more advantages in chemotherapy and Etoposide should not be ignored in ovarian tumors.

The Article COMPARISON OF LX-8000R AND URISED 2 FULL-AUTOMATED URINE ANALIZERS WITH MANUAL MICROSCOPIC EXAMINATION

Background: Urinalysis has an important place in evaluating kidney and urinary tract infections. Automated urine analyzers enhance productivity and turnover in laboratories and economize time and labor required for analysis. In the present study, we evaluated and compared analytic and diagnostic performance of UriSed2 with LX-8000R, which is a novel image-based automated urine sediment analyzer. Methods: A total of 178 urine samples sent to our laboratory were evaluated by the two urine analyzers and standard manual microscopy. Precision and comparison studies were done in accordance with CLSI guidelines. Results: Sensitivity assessment revealed similar outcomes with both UriSed2 and LX-8000R devices for erythrocyte count (RBC), whereas UriSed2 device yielded higher outcomes for leukocyte count (WBC) and epithelial cells (EPI) than LX-8000R analyzer. Specificity of UriSed2 for WBC and RBC was higher than that of LX-8000R device. According to Gamma statistics, both urine analyzers showed perfect consistency for WBC, RBC and EPI cell counts. Manuel microscopy revealed statistically significant correlation between LX-8000R and UriSed2 in terms of WBC and RBC. Manual evaluation by Bland-Altman analysis demonstrated lower WBC and RBC values and higher EPI as compared to both UriSed2 and LX-8000R devices. As the result of Passing-Bablok regression analysis, both devices were found to be inconsistent with manual microscopy. Conclusion: We think that evaluation of automated urine analyzers will be more meaningful when they are evaluated together with urine samples and patient clinic in addition to comparing with manual microscopy.

An Integrated Sensitivity Analysis Method for Energy and Comfort Performance of an Office Building along the Chinese Coastline

This study aimed to evaluate the comprehensive percentage influence of input parameters on building energy and comfort performance by a new approach of sensitivity analysis (SA) and explore the most reliable and neutral sampling and sensitivity assessment method. The research combined 7 sampling methods with 13 SA methods to comprehensively integrate the percentage influence of 25 input parameters on building energy and comfort performance in 24 coastal cities of China. The results have found that the percentage influence of many important input parameters is affected by geographical position. Considering both energy and comfort performance of the building, the key parameters are heating setpoint, infiltration rate, cooling setpoint, roof U value, roof solar absorptance, window solar heat gain coefficient, equipment, and occupant density, all of which could comprehensively impact 70% of energy demand and comfort performance along the Chinese coastline. This is of great significance for policymakers to formulate relative building regulations. After comparing the F-test and the exceed percentage test, we recommended the Pearson with Quasi-random sampling method as the most reliable SA assessment method in building simulation, followed by the standardized regression coefficient in random sampling and Latin hypercube sampling methods, which can achieve data closest to the average value.

FUCOM-MARCOS based Group Decision-making using Dombi Power Aggregation of Dual Probabilistic Linguistic Information

The dual probabilistic linguistic (DPL) term sets are considered superior to probabilistic linguistic term sets. The power average operator can lessen the effects of the extreme assessing data from some decision-makers with prejudice. Further, the Dombi operators are quite flexible with the general parameter during the aggregation process. Moreover, based on deviation from the maximum consistency by the exclusion of the concern of the redundancy of the comparisons made in criteria pairs, FUCOM (full consistency method) is utilized as a subjective criteria weight computing model. Besides, MARCOS (Measurements alternatives and ranking according to compromise solution) method is based on the determination of utility degrees according to the distance from anti-ideal and ideal solutions and their aggregations. In this study, we combine the merits of power average operator, Dombi operator, FUCOM technique and MARCOS for dealing with multi-criteria group decision-making (MCGDM) problems under a DPL setting where rank of the alternatives are obtained through MARCOS method. For aggregating decision-experts preferences, we propose two types of operators, namely- DPL Dombi power weighted averaging and DPL Dombi power weighted geometric aggregation operators. We discuss the elegant properties of these proposed aggregation operators. We provide a case study regarding open source software learning management system selection to focus the practicability and usefulness of the proposed approach. Furthermore, we perform a sensitivity assessment on diverse criteria weight sets in order to test the stability of our developed intriguing approach. To this effect, we also provide a comparison between our approach with various extant methods.

Techno-Economic Assessment of a Grid-Independent Hybrid Power Plant for Co-Supplying a Remote Micro-Community with Electricity and Hydrogen

This study investigates the techno-economic feasibility of an off-grid integrated solar/wind/hydrokinetic plant to co-generate electricity and hydrogen for a remote micro-community. In addition to the techno-economic viability assessment of the proposed system via HOMER (hybrid optimization of multiple energy resources), a sensitivity analysis is conducted to ascertain the impact of ±10% fluctuations in wind speed, solar radiation, temperature, and water velocity on annual electric production, unmet electricity load, LCOE (levelized cost of electricity), and NPC (net present cost). For this, a far-off village with 15 households is selected as the case study. The results reveal that the NPC, LCOE, and LCOH (levelized cost of hydrogen) of the system are equal to $333,074, 0.1155 $/kWh, and 4.59 $/kg, respectively. Technical analysis indicates that the PV system with the rated capacity of 40 kW accounts for 43.7% of total electricity generation. This portion for the wind turbine and the hydrokinetic turbine with nominal capacities of 10 kW and 20 kW equates to 23.6% and 32.6%, respectively. Finally, the results of sensitivity assessment show that among the four variables only a +10% fluctuation in water velocity causes a 20% decline in NPC and LCOE.