Background:Information on the possibility of drawing up Advance Directives(AD)is a necessity,and represents a major medical,ethical,and legal challenge.The difficulties are numerous,both organizational and cultural,an...Background:Information on the possibility of drawing up Advance Directives(AD)is a necessity,and represents a major medical,ethical,and legal challenge.The difficulties are numerous,both organizational and cultural,and this is also true in the context of oncology,where ADs(and more broadly,advanced palliative care)are of critical importance.As an eminently sensitive subject,dealing with ADs(and therefore with end-of-life issues)requires both societal and medical/health-care acculturation.An institutional approach has therefore been developed,to deploy information tools,training professionals,and formalize the collection of AD.Such an approach cannot be implemented without an assessment not only of its objective results but also above all of its psychological effects,on both users(patients,family caregivers)and professionals.Methods:This longitudinal study,based on a mixed-method,interdisciplinary approach,will assess the impact of this information dissemination on AD,in terms of both potential positive and negative effects,using validated measurement methods.Thus,this study follows the 5 criteria of the RE-AIM model,designed to analyze the interest and impact of a device intended for users of the healthcare system;we will use a mixed methodology,relying on both a quantitative component(counting the number of people benefiting from the scheme,and those requesting support in drawing up their DA...,administering questionnaires),as well as a qualitative component(focus groups)which will enable us to study the subjective experiences of users,their relatives and the professionals involved in the scheme.Results:The results of this study will make it possible to determine the effects of this system of assistance in the drafting of ADs,which is currently being promoted by the legislator,but which is struggling to be implemented.展开更多
There has been a significant decline in cardiovascular morbidity and mortality amidst pervasive advances in care, including percutane- ous revascularization, mechanical circulatory support, and transcatheter valvular ...There has been a significant decline in cardiovascular morbidity and mortality amidst pervasive advances in care, including percutane- ous revascularization, mechanical circulatory support, and transcatheter valvular therapies. While advancing therapies may add significant longevity, they also bring about new end-of-life decision-making challenges for patients and their families who also must weigh the advan- tages of reduced mortality to the possibility of longer lives consisting of high morbidity, frailty, pain, and poor quality of living. Advance care entails options of withholding or withdrawing therapies, and has become a familiar part of cardiovascular care for older patients in Western countries. However, as advanced cardiovascular practices extend to developing countries, the interrelated concept of advance care is rarely straight forward as it is affected by local cultural traditions and mores, and can lead to very different inferences and use. This paper discusses the concepts of advance care planning, surrogate decision-making, orders for resuscitation and futility in patients with cardiac dis- ease with comparisons of West to East, focusing particularly on the United States versus India.展开更多
Reinforcement learning-based traffic signal control systems (RLTSC) can enhance dynamic adaptability, save vehicle travelling timeand promote intersection capacity. However, the existing RLTSC methods do not consider ...Reinforcement learning-based traffic signal control systems (RLTSC) can enhance dynamic adaptability, save vehicle travelling timeand promote intersection capacity. However, the existing RLTSC methods do not consider the driver’s response time requirement, sothe systems often face efficiency limitations and implementation difficulties.We propose the advance decision-making reinforcementlearning traffic signal control (AD-RLTSC) algorithm to improve traffic efficiency while ensuring safety in mixed traffic environment.First, the relationship between the intersection perception range and the signal control period is established and the trust region state(TRS) is proposed. Then, the scalable state matrix is dynamically adjusted to decide the future signal light status. The decision will bedisplayed to the human-driven vehicles (HDVs) through the bi-countdown timer mechanism and sent to the nearby connected automatedvehicles (CAVs) using the wireless network rather than be executed immediately. HDVs and CAVs optimize the driving speedbased on the remaining green (or red) time. Besides, the Double Dueling Deep Q-learning Network algorithm is used for reinforcementlearning training;a standardized reward is proposed to enhance the performance of intersection control and prioritized experiencereplay is adopted to improve sample utilization. The experimental results on vehicle micro-behaviour and traffic macro-efficiencyshowed that the proposed AD-RLTSC algorithm can simultaneously improve both traffic efficiency and traffic flow stability.展开更多
文摘Background:Information on the possibility of drawing up Advance Directives(AD)is a necessity,and represents a major medical,ethical,and legal challenge.The difficulties are numerous,both organizational and cultural,and this is also true in the context of oncology,where ADs(and more broadly,advanced palliative care)are of critical importance.As an eminently sensitive subject,dealing with ADs(and therefore with end-of-life issues)requires both societal and medical/health-care acculturation.An institutional approach has therefore been developed,to deploy information tools,training professionals,and formalize the collection of AD.Such an approach cannot be implemented without an assessment not only of its objective results but also above all of its psychological effects,on both users(patients,family caregivers)and professionals.Methods:This longitudinal study,based on a mixed-method,interdisciplinary approach,will assess the impact of this information dissemination on AD,in terms of both potential positive and negative effects,using validated measurement methods.Thus,this study follows the 5 criteria of the RE-AIM model,designed to analyze the interest and impact of a device intended for users of the healthcare system;we will use a mixed methodology,relying on both a quantitative component(counting the number of people benefiting from the scheme,and those requesting support in drawing up their DA...,administering questionnaires),as well as a qualitative component(focus groups)which will enable us to study the subjective experiences of users,their relatives and the professionals involved in the scheme.Results:The results of this study will make it possible to determine the effects of this system of assistance in the drafting of ADs,which is currently being promoted by the legislator,but which is struggling to be implemented.
文摘There has been a significant decline in cardiovascular morbidity and mortality amidst pervasive advances in care, including percutane- ous revascularization, mechanical circulatory support, and transcatheter valvular therapies. While advancing therapies may add significant longevity, they also bring about new end-of-life decision-making challenges for patients and their families who also must weigh the advan- tages of reduced mortality to the possibility of longer lives consisting of high morbidity, frailty, pain, and poor quality of living. Advance care entails options of withholding or withdrawing therapies, and has become a familiar part of cardiovascular care for older patients in Western countries. However, as advanced cardiovascular practices extend to developing countries, the interrelated concept of advance care is rarely straight forward as it is affected by local cultural traditions and mores, and can lead to very different inferences and use. This paper discusses the concepts of advance care planning, surrogate decision-making, orders for resuscitation and futility in patients with cardiac dis- ease with comparisons of West to East, focusing particularly on the United States versus India.
基金Science&Technology Research and Development Program of China Railway(Grant No.N2021G045)the Beijing Municipal Natural Science Foundation(Grant No.L191013)the Joint Funds of the Natural Science Foundation of China(Grant No.U1934222).
文摘Reinforcement learning-based traffic signal control systems (RLTSC) can enhance dynamic adaptability, save vehicle travelling timeand promote intersection capacity. However, the existing RLTSC methods do not consider the driver’s response time requirement, sothe systems often face efficiency limitations and implementation difficulties.We propose the advance decision-making reinforcementlearning traffic signal control (AD-RLTSC) algorithm to improve traffic efficiency while ensuring safety in mixed traffic environment.First, the relationship between the intersection perception range and the signal control period is established and the trust region state(TRS) is proposed. Then, the scalable state matrix is dynamically adjusted to decide the future signal light status. The decision will bedisplayed to the human-driven vehicles (HDVs) through the bi-countdown timer mechanism and sent to the nearby connected automatedvehicles (CAVs) using the wireless network rather than be executed immediately. HDVs and CAVs optimize the driving speedbased on the remaining green (or red) time. Besides, the Double Dueling Deep Q-learning Network algorithm is used for reinforcementlearning training;a standardized reward is proposed to enhance the performance of intersection control and prioritized experiencereplay is adopted to improve sample utilization. The experimental results on vehicle micro-behaviour and traffic macro-efficiencyshowed that the proposed AD-RLTSC algorithm can simultaneously improve both traffic efficiency and traffic flow stability.
