Influencing factors of home hospice care needs of the older adults with chronic diseases at the end of life in China: a cross-sectional study.

Introduction: Chronic diseases are becoming a serious threat to the physical and mental health of older people in China as their aging process picks up speed. Home hospice care addresses diverse needs and enhances the quality of life for older adult individuals nearing the end of life. To ensure the well-being of chronically ill older adults at the end of life, it is vital to explore and assess the multidimensional hospice needs of terminally ill older individuals in their homes. The aim of this study was to investigate the current situation of home hospice care needs of Chinese older adults with chronic diseases at the end of life, and to analyze the influencing factors (sociodemographic and disease-related factors). Methods: In this cross-sectional study, 247 older adult people with chronic diseases at the end of life were selected from the communities of 4 community health service centers in Jinzhou City, Liaoning Province from June to October 2023 by random sampling method. A general information questionnaire and the home hospice care needs questionnaire developed by our research group were used to investigate. Independent samples t-test or one-way ANOVA was used to compare the differences in the scores of different characteristics, and the factors with significant differences were selected for multivariate linear regression analysis to determine the final influencing factors. Results: The total score of home hospice needs of the dying older adult was 115.70 ± 12, with the mean scores for each dimension in descending order being Information Needs (3.96 ± 0.61), Social Support Needs (3.96 ± 0.44), Spiritual Needs (3.92 ± 0.43), Physical Needs (3.60 ± 0.59), Psychological Needs (3.37 ± 0.65). Status of residence, duration of illness (year), the type of disease, and self-care ability were influential factors in the total score of home hospice needs. Discussion: The need for hospice care for the terminally ill older adult is high, and healthcare professionals should implement services according to the influencing factors of need to meet their multidimensional needs and improve their quality of life.

Van der Waals polarity-engineered 3D integration of 2D complementary logic.

Vertical three-dimensional integration of two-dimensional (2D) semiconductors holds great promise, as it offers the possibility to scale up logic layers in the z axis1-3. Indeed, vertical complementary field-effect transistors (CFETs) built with such mixed-dimensional heterostructures4,5, as well as hetero-2D layers with different carrier types6-8, have been demonstrated recently. However, so far, the lack of a controllable doping scheme (especially p-doped WSe2 (refs. 9-17) and MoS2 (refs. 11,18-28)) in 2D semiconductors, preferably in a stable and non-destructive manner, has greatly impeded the bottom-up scaling of complementary logic circuitries. Here we show that, by bringing transition metal dichalcogenides, such as MoS2, atop a van der Waals (vdW) antiferromagnetic insulator chromium oxychloride (CrOCl), the carrier polarity in MoS2 can be readily reconfigured from n- to p-type via strong vdW interfacial coupling. The consequential band alignment yields transistors with room-temperature hole mobilities up to approximately 425 cm2 V-1 s-1, on/off ratios reaching 106 and air-stable performance for over one year. Based on this approach, vertically constructed complementary logic, including inverters with 6 vdW layers, NANDs with 14 vdW layers and SRAMs with 14 vdW layers, are further demonstrated. Our findings of polarity-engineered p- and n-type 2D semiconductor channels with and without vdW intercalation are robust and universal to various materials and thus may throw light on future three-dimensional vertically integrated circuits based on 2D logic gates.

Influencing factors of home hospice care needs of family caregivers of the older adult with chronic diseases at the end of life in China: a cross-sectional study.

Introduction: With increased life expectancy in the Chinese population coupled with chronic disease the care needs of people at the end of life are attracting much attention. Home hospice care can help the dying older adult achieve comfort and maintain their dignity at home. However, dying at home means great responsibility and challenge for family caregivers, and there are many unmet needs. The study aimed to investigate the home hospice care needs of family caregivers of older adult people with chronic diseases at the end of life in China, and to analyze the influencing factors of home hospice care needs of caregivers. Methods: In this cross-sectional study, from May to September 2023, 4 community health service centers were selected by stratified sampling from seven administrative districts in Jinzhou City, Liaoning Province, where home hospice care was piloted. Then 224 family caregivers were selected from the communities of seven community service centers by simple random sampling method. A general information questionnaire and the home hospice care needs questionnaire developed by our research group were used to investigate. Univariate analysis was used to compare the differences in the scores of different characteristics, and the factors with significant differences were selected for multivariate linear regression analysis to determine the final influencing factors. Results: The total score of hospice care needs of family caregivers was 121.61 ± 15.24, among which the end-of-life knowledge need dimension score was 24.04 ± 2.71, the highest score index was 80.13%, while the symptom control need score was 15.58 ± 3.39, the lowest score index was 62.32%. In addition, Caregivers with caregiving experience, dying older adult with longer disease duration, and dying older adult with higher levels of education were the factors influencing the total need for home hospice care among family caregivers, with a variance explained of 22.7%. Discussion: The needs of family caregivers of the terminally ill older adult are high, and healthcare professionals should implement services to meet their multidimensional needs and improve the quality of care according to the factors affecting their needs.

Layer-by-layer phase transformation in Ti3O5 revealed by machine-learning molecular dynamics simulations.

Reconstructive phase transitions involving breaking and reconstruction of primary chemical bonds are ubiquitous and important for many technological applications. In contrast to displacive phase transitions, the dynamics of reconstructive phase transitions are usually slow due to the large energy barrier. Nevertheless, the reconstructive phase transformation from ß- to λ-Ti3O5 exhibits an ultrafast and reversible behavior. Despite extensive studies, the underlying microscopic mechanism remains unclear. Here, we discover a kinetically favorable in-plane nucleated layer-by-layer transformation mechanism through metadynamics and large-scale molecular dynamics simulations. This is enabled by developing an efficient machine learning potential with near first-principles accuracy through an on-the-fly active learning method and an advanced sampling technique. Our results reveal that the ß-λ phase transformation initiates with the formation of two-dimensional nuclei in the ab-plane and then proceeds layer-by-layer through a multistep barrier-lowering kinetic process via intermediate metastable phases. Our work not only provides important insight into the ultrafast and reversible nature of the ß-λ transition, but also presents useful strategies and methods for tackling other complex structural phase transitions.

Single [0001]-oriented zinc metal anode enables sustainable zinc batteries.

The optimization of crystalline orientation of a Zn metal substrate to expose more Zn(0002) planes has been recognized as an effective strategy in pursuit of highly reversible Zn metal anodes. However, the lattice mismatch between substrate and overgrowth crystals has hampered the epitaxial sustainability of Zn metal. Herein, we discover that the presence of crystal grains deviating from [0001] orientation within a Zn(0002) metal anode leads to the failure of epitaxial mechanism. The electrodeposited [0001]-uniaxial oriented Zn metal anodes with a single (0002) texture fundamentally eliminate the lattice mismatch and achieve ultra-sustainable homoepitaxial growth. Using high-angle angular dark-filed scanning transmission electron microscopy, we elucidate the homoepitaxial growth of the deposited Zn following the "~ABABAB~" arrangement on the Zn(0002) metal from an atomic-level perspective. Such consistently epitaxial behavior of Zn metal retards dendrite formation and enables improved cycling, even in Zn||NH4V4O10 pouch cells, with a high capacity of 220 mAh g-1 for over 450 cycles. The insights gained from this work on the [0001]-oriented Zn metal anode and its persistently homoepitaxial mechanism pave the way for other metal electrodes with high reversibility.

Dual quantum spin Hall insulator by density-tuned correlations in TaIrTe4.

The convergence of topology and correlations represents a highly coveted realm in the pursuit of new quantum states of matter1. Introducing electron correlations to a quantum spin Hall (QSH) insulator can lead to the emergence of a fractional topological insulator and other exotic time-reversal-symmetric topological order2-8, not possible in quantum Hall and Chern insulator systems. Here we report a new dual QSH insulator within the intrinsic monolayer crystal of TaIrTe4, arising from the interplay of its single-particle topology and density-tuned electron correlations. At charge neutrality, monolayer TaIrTe4 demonstrates the QSH insulator, manifesting enhanced nonlocal transport and quantized helical edge conductance. After introducing electrons from charge neutrality, TaIrTe4 shows metallic behaviour in only a small range of charge densities but quickly goes into a new insulating state, entirely unexpected on the basis of the single-particle band structure of TaIrTe4. This insulating state could arise from a strong electronic instability near the van Hove singularities, probably leading to a charge density wave (CDW). Remarkably, within this correlated insulating gap, we observe a resurgence of the QSH state. The observation of helical edge conduction in a CDW gap could bridge spin physics and charge orders. The discovery of a dual QSH insulator introduces a new method for creating topological flat minibands through CDW superlattices, which offer a promising platform for exploring time-reversal-symmetric fractional phases and electromagnetism2-4,9,10.

Maximally localized Wannier functions, interaction models, and fractional quantum anomalous Hall effect in twisted bilayer MoTe2.

We investigate the moiré band structures and the strong correlation effects in twisted bilayer MoTe[Formula: see text] for a wide range of twist angles, employing a combination of various techniques. Using large-scale first-principles calculations, we pinpoint realistic continuum modeling parameters, subsequently deriving the maximally localized Wannier functions for the top three moiré bands. Simplifying our model with reasonable assumptions, we obtain a minimal two-band model, encompassing Coulomb repulsion, correlated hopping, and spin exchange. Our minimal interaction models pave the way for further exploration of the rich many-body physics in twisted MoTe[Formula: see text]. Furthermore, we explore the phase diagrams of the system through Hartree-Fock approximation and exact diagonalization (ED). Our two-band ED analysis underscores significant band-mixing effects in this system, which enlarge the optimal twist angle for fractional quantum anomalous Hall states.

Phonon stability boundary and deep elastic strain engineering of lattice thermal conductivity.

Recent studies have reported the experimental discovery that nanoscale specimens of even a natural material, such as diamond, can be deformed elastically to as much as 10% tensile elastic strain at room temperature without the onset of permanent damage or fracture. Computational work combining ab initio calculations and machine learning (ML) algorithms has further demonstrated that the bandgap of diamond can be altered significantly purely by reversible elastic straining. These findings open up unprecedented possibilities for designing materials and devices with extreme physical properties and performance characteristics for a variety of technological applications. However, a general scientific framework to guide the design of engineering materials through such elastic strain engineering (ESE) has not yet been developed. By combining first-principles calculations with ML, we present here a general approach to map out the entire phonon stability boundary in six-dimensional strain space, which can guide the ESE of a material without phase transitions. We focus on ESE of vibrational properties, including harmonic phonon dispersions, nonlinear phonon scattering, and thermal conductivity. While the framework presented here can be applied to any material, we show as an example demonstration that the room-temperature lattice thermal conductivity of diamond can be increased by more than 100% or reduced by more than 95% purely by ESE, without triggering phonon instabilities. Such a framework opens the door for tailoring of thermal-barrier, thermoelectric, and electro-optical properties of materials and devices through the purposeful design of homogeneous or inhomogeneous strains.

Development and Validation of the Home Hospice Care Needs Questionnaire for the Dying Old Adult (HHCNQ-DE) in Mainland China.

Context: Home hospice needs assessment is the key to the development of home hospice services. Therefore, there is a need to develop assessment tools in mainland China to meet the comprehensive needs of the old adult at the end of life. Objective: To develop and validate a tool to assess Chinese mainland palliative care needs of the dying old adult at home. Methods: Using the Harmony Nursing Theory as a theoretical framework, through reference to the China home hospice care needs scale, literature research, in-depth conversations with the dying old adult, and group discussions among members of the research team, 43 original questionnaire items were preliminarily drafted. A 31-item predictive questionnaire was formed through 2 rounds of expert review and small sample testing. From April to September 2023, 199 old adult at the end of life at home in Jinzhou, Liaoning Province were investigated to determine the reliability and validity of the questionnaire. Results: The final questionnaire included 31 items. Exploratory factor analysis extracted 5 common factors, and the cumulative variance contribution rate was 68.811%; the Cronbach's alpha coefficient of the total questionnaire was 0.832, and the re-test reliability was .806; the content validity index of the questionnaire was 0.982, and the content validity index of the items was 0.83-1.00. Conclusion: The construction method of the HHCNQ-DE is scientific and reliable, with good reliability and validity, and it can be used as a tool to measure the needs of home hospice care in mainland China in the future.

Dual-Mode Conversion of Photodetector and Neuromorphic Vision Sensor via Bias Voltage Regulation on a Single Device.

Simultaneous implementation of photodetector and neuromorphic vision sensor (NVS) on a single device faces a great challenge, due to the inherent speed discrepancy in their photoresponse characteristics. In this work, a trench-bridged GaN/Ga2 O3 /GaN back-to-back double heterojunction array device is fabricated to enable the advanced functionalities of both devices on a single device. Interestingly, the device shows fast photoresponse and persistent photoconductivity behavior at low and high voltages, respectively, through the modulation of oxygen vacancy ionization and de-ionization processes in Ga2 O3 . Consequently, the role of the optoelectronic device can be altered between the photodetector and NVS by simply adjusting the magnitude of bias voltage. As a photodetector, the device is able to realize fast optical imaging and optical communication functions. On the other hand, the device exhibits outstanding image sensing, image memory, and neuromorphic visual pre-processing as an NVS. The utilization of NVS for image pre-processing leads to a noticeable enhancement in both recognition accuracy and efficiency. The results presented in this work not only offer a new avenue to obtain complex functionality on a single optoelectronic device but also provide opportunities to implement advanced robotic vision systems and neuromorphic computing.

Direct Observation of Topological Phonons in Graphene.

Phonons, as the most fundamental emergent bosons in condensed matter systems, play an essential role in the thermal, mechanical, and electronic properties of crystalline materials. Recently, the concept of topology has been introduced to phonon systems, and the nontrivial topological states also exist in phonons due to the constraint by the crystal symmetry of the space group. Although the classification of various topological phonons has been enriched theoretically, experimental studies were limited to several three-dimensional (3D) single crystals with inelastic x-ray or neutron scatterings. The experimental evidence of topological phonons in two-dimensional (2D) materials is absent. Here, using high-resolution electron energy loss spectroscopy following our theoretical predictions, we directly map out the phonon spectra of the atomically thin graphene in the entire 2D Brillouin zone, and observe two nodal-ring phonons and four Dirac phonons. The closed loops of nodal-ring phonons and the conical structure of Dirac phonons in 2D momentum space are clearly revealed by our measurements, in nice agreement with our theoretical calculations. The ability of 3D mapping (2D momentum space and energy space) of phonon spectra opens up a new avenue to the systematic identification of the topological phononic states. Our work lays a solid foundation for potential applications of topological phonons in superconductivity, dynamic instability, and phonon diode.

An Ion-Sieving Janus Separator toward Planar Electrodeposition for Deeply Rechargeable Zn-Metal Anodes.

The irregular and random electrodeposition of zinc has emerged as a non-negligible barrier for deeply rechargeable aqueous zinc (Zn)-ion batteries (AZIBs), yet traditional texture regulation of the Zn substrate cannot continuously induce uniform Zn deposition. Here, a Janus separator is constructed via parallelly grown graphene sheets modified with sulfonic cellulose on one side of the commercial glass fiber separator through the spin-coating technique. The Janus separator can consistently regulate Zn growth toward a locked crystallographic orientation of Zn(002) texture to intercept dendrites. Furthermore, the separator can spontaneously repel SO4 2- and anchor H+ while allowing effective transport of Zn2+ to alleviate side reactions. Accordingly, the Zn symmetric cell harvests a long-term lifespan over 1400 h at 10 mA cm-2 /10 mAh cm-2 and endures stable cycling over 220 h even at a high depth of discharge (DOD) of 56%. The Zn/carbon nanotube (CNT)-MnO2 cell achieves an outstanding capacity retention of 95% at 1 A g-1 after 1900 cycles. Furthermore, the Zn/NH4 V4 O10 pouch cell with a Janus separator delivers an initial capacity of 178 mAh g-1 and a high capacity retention of 87.4% after 260 cycles. This work provides a continuous regulation approach to achieve crystallographic homogeneity of the Zn anode, which can be suitable for other metal batteries.

Topological phononic materials: Computation and data.

Considering the current volume of materials data, it is impossible to investigate each compound by trial-and-error experiments involving labor-intensive efforts. The scientists in the Shenyang National Laboratory for Materials Science developed a home-made software, HT-PHONON, selecting over 5,000 topological phononic (TP) materials out of 13,000 materials within high-throughput computational materials design combined with a big data analysis. Furthermore, an online database for TP materials has been constructed, which is now freely open to the public community through the website www.phonon.synl.ac.cn. In this perspective, we review this platform and discuss exciting consequences of TP materials that are expected from manipulating the phonons, linking fundamental research to potential applications.

Computation and data driven discovery of topological phononic materials.

The discovery of topological quantum states marks a new chapter in both condensed matter physics and materials sciences. By analogy to spin electronic system, topological concepts have been extended into phonons, boosting the birth of topological phononics (TPs). Here, we present a high-throughput screening and data-driven approach to compute and evaluate TPs among over 10,000 real materials. We have discovered 5014 TP materials and grouped them into two main classes of Weyl and nodal-line (ring) TPs. We have clarified the physical mechanism for the occurrence of single Weyl, high degenerate Weyl, individual nodal-line (ring), nodal-link, nodal-chain, and nodal-net TPs in various materials and their mutual correlations. Among the phononic systems, we have predicted the hourglass nodal net TPs in TeO3, as well as the clean and single type-I Weyl TPs between the acoustic and optical branches in half-Heusler LiCaAs. In addition, we found that different types of TPs can coexist in many materials (such as ScZn). Their potential applications and experimental detections have been discussed. This work substantially increases the amount of TP materials, which enables an in-depth investigation of their structure-property relations and opens new avenues for future device design related to TPs.

Underlying Topological Dirac Nodal Line Mechanism of the Anomalously Large Electron-Phonon Coupling Strength on a Be (0001) Surface.

Beryllium has recently been discovered to harbor a Dirac nodal line (DNL) in its bulk phase and the DNL-induced nontrivial surface states (DNSSs) on its (0001) surface, rationalizing several already-existing historic puzzles [Phys. Rev. Lett. 117, 096401 (2016)PRLTAO0031-900710.1103/PhysRevLett.117.096401]. However, to date the underlying mechanism as to why its (0001) surface exhibits an anomalously large electron-phonon coupling effect (λ_{e-ph}^{s}≈1.0) remains unresolved. Here, by means of first-principles calculations, we show that the coupling of the DNSSs with the phononic states mainly contributes to its novel surface e-ph enhancement. Besides the fact that the experimentally observed λ_{e-ph}^{s} and the main Eliashberg coupling function (ECF) peaks are reproduced well in our current calculations, we decompose the ECF α^{2}F(k,q;v) and the e-ph coupling strength λ(k,q;v) as a function of each electron momentum (k), each phonon momentum (q), and each phonon mode (v), evidencing the robust connection between the DNSSs and both α^{2}F(k,q;v) and λ(k,q;v). The results reveal the strong e-ph coupling between the DNSSs and the phonon modes, which contributes over 80% of the λ_{e-ph}^{s} coefficient on the Be (0001) surface. It highlights that the anomalously large e-ph coefficient on the Be (0001) surface can be attributed to the presence of its DNL-induced DNSSs, clarifying the long-debated mechanism.

Energy storage properties of a two-dimensional TiB4 monolayer.

Herein, the energy storage properties of TiB4 monolayers were studied within the density functional theory framework. Both CH4 and H2 were chosen as adsorption molecules, and their interactions with a TiB4 sheet were investigated. TiB4 attracted gas molecules via open Ti sites, and each Ti atom could adsorb a maximum of two molecules. Via the electronic density of the states and atomic charge analysis, we found that the mechanism for gas adsorption was mainly electrostatic. For H2 adsorption cases, orbital interactions also made contributions. As the combustion energy of one CH4 molecule is three times that of one H2, the TiB4-2CH4 compound can achieve the best equivalent gravimetric hydrogen density of 10.14 wt% with the average adsorption energy of 0.38 eV. Ab initio molecular dynamics calculations on this compound showed that there was no kinetic barrier during CH4 desorption. Moreover, the stacking of the TiB4 monolayers could weaken the energy storage capacity. Therefore, it should be avoided in practial usage. Based on the abovementioned results, the TiB4 monolayer was suggested to be a promising candidate for onboard energy storage.