This study supports that a combination of lecture, case-based learning, and simulation with SPs can increase nursing students’ cultural competence.

With the global aging process intensified, the demand for end-of-life care has surged, especially in China. However, its development is restricted. RK33 Understanding the life and death attitude among the elderly and its formation process, and clarifying their needs, are so important to promote social popularization of end-of-life care.

This qualitative study included 20 elderly residents in Nan and Shuangbei Communities, Chongqing City, People’s Republic of China. Data were collected through semistructured in-depth individual interviews and processed by thematic analysis method.

Three themes and eight subthemes were identified Characteristics of formation process (passive thinking, closed and single), life-and-death attitude (cherish and enjoy life, quality of life priority, let death take its course) and expectations of end-of-life care (preferences, basic needs, good death).

Life-and-death attitude and end-of-life care expectations of the elderly support the development and delivery of end-of-life care. Furthermore, the individual-family-hospital linkage discussion channel needs to be further explored.

Life-and-death attitude and end-of-life care expectations of the elderly support the development and delivery of end-of-life care. Furthermore, the individual-family-hospital linkage discussion channel needs to be further explored.In this paper, a novel modified optimization algorithm is presented, which combines Nelder-Mead (NM) method with a gradient-based approach. The well-known Nelder Mead optimization technique is widely used but it suffers from convergence issues in higher dimensional complex problems. Unlike the NM, in this proposed technique we have focused on two issues of the NM approach, one is shape of the simplex which is reshaped at each iteration according to the objective function, so we used a fixed shape of the simplex and we regenerate the simplex at each iteration and the second issue is related to reflection and expansion steps of the NM technique in each iteration, NM used fixed value of α, that is, α = 1 for reflection and α = 2 for expansion and replace the worst point of the simplex with that new point in each iteration. In this way NM search the optimum point. In proposed algorithm the optimum value of the parameter α is computed and then centroid of new simplex is originated at this optimum point and regenerate the simplex with this centroid in each iteration that optimum value of α will ensure the fast convergence of the proposed technique. The proposed algorithm has been applied to the real time implementation of the transversal adaptive filter. The application used to demonstrate the performance of the proposed technique is a well-known convex optimization problem having quadratic cost function, and results show that the proposed technique shows fast convergence than the Nelder-Mead method for lower dimension problems and the proposed technique has also good convergence for higher dimensions, that is, for higher filter taps problem. The proposed technique has also been compared with stochastic techniques like LMS and NLMS (benchmark) techniques. The proposed technique shows good results against LMS. The comparison shows that the modified algorithm guarantees quite acceptable convergence with improved accuracy for higher dimensional identification problems.

Current guidelines for cardiopulmonary resuscitation (CPR) recommend that standard-dose epinephrine be administered every 3-5 minutes during cardiac arrest. However, there is a knowledge gap regarding the optimal epinephrine dosing interval. This study aimed to examine the association between epinephrine dosing intervals and outcomes after out-of-hospital cardiac arrest (OHCA).

This was a nationwide population-based observational study using data from a Japanese government-led registry of OHCA, including patients who experienced OHCA in Japan from 2011 to 2017. We defined the epinephrine dosing interval as the time interval between the first epinephrine administration and return of spontaneous circulation in the prehospital setting, divided by the total number of epinephrine doses. The primary outcome was 1-month neurologically favorable survival.

A total of 10,965 patients (mean (SD) age, 75.8 (14.3) years; 59.8% male) were included. The median epinephrine dosing interval was 3.5 minutes (IQR, 2.5-4.5; mean (SD), 3.6 (1.8)). Only approximately half of the patients received epinephrine administration with a standard dosing interval, as recommended in the current CPR guidelines. After multivariable adjustment, compared with the standard dosing interval, neither shorter nor longer epinephrine dosing intervals were associated with neurologically favorable survival after OHCA (Short vs Standard adjusted OR 0.87 [95%CI 0.66-1.15]; and Long vs Standard adjusted OR 1.08 [95%CI 0.76-1.55]). Similar associations were observed in propensity score-matched analyses.

The epinephrine dosing interval was not associated with 1-month neurologically favorable survival after OHCA. Our findings do not deny the recommended epinephrine dosing interval in the current CPR guidelines.

The epinephrine dosing interval was not associated with 1-month neurologically favorable survival after OHCA. Our findings do not deny the recommended epinephrine dosing interval in the current CPR guidelines.

Pregnancy can make it difficult to cope with demands at work and may affect women’s well-being. We investigated if a manager-targeted educational intervention reduced demanding occupational exposures and improved the psychosocial work environment and well-being among pregnant employees.

Data came from a cluster randomised trial in Danish hospitals and day-care institutions. Work units were assigned randomly and were non-blinded to the intervention, where managers were either invited to participate in a three-hour seminar addressing job adjustment in pregnancy or assigned to a control group undertaking their usual practice. Self-reported outcomes by pregnant employees at the work units were the proportion of pregnant employees with demanding occupational exposures, good psychosocial work environment and good well-being. Mixed logistic regression was applied in the population of responders and in intention-to-treat analyses using multiple imputations.

We included 915 pregnant employees 451 in the intervention group and 464 in the control group.