Manipulation of Moiré Superlattice in Twisted Monolayer-multilayer Graphene by Moving Nanobubbles.

In the heterostructure of two-dimensional (2D) materials, many novel physics phenomena are strongly dependent on the Moiré superlattice. How to achieve the continuous manipulation of the Moiré superlattice in the same sample is very important to study the evolution of various physical properties. Here, in minimally twisted monolayer-multilayer graphene, we found that bubble-induced strain has a huge impact on the Moiré superlattice. By employing the AFM tip to dynamically and continuously move the nanobubble, we realized the modulation of the Moiré superlattice, like the evolution of regular triangular domains into long strip domain structures with single or double domain walls. We also achieved controllable modulation of the Moiré superlattice by moving multiple nanobubbles and establishing the coupling of nanobubbles. Our work presents a flexible method for continuous and controllable manipulation of Moiré superlattices, which will be widely used to study novel physical properties in 2D heterostructures.

Development and psychometric evaluation of the hidden curriculum assessment scale in nursing education: A validity and reliability study.

AIMS: The study aimed to develop and psychometrically evaluate a measurement scale for identifying and assessing the hidden curriculum in undergraduate nursing education. BACKGROUND: The hidden curriculum is a general term for educational information that exists outside of the teaching program and mainly affects students' knowledge, emotions, behaviors, beliefs, values and professional ethics. However, a specific instrument to comprehensively define and assess the hidden curriculum in nursing education has not yet been developed in China. DESIGN: A descriptive and explorative study design was used. METHODS: We developed the initial scale through a literature review, focus group discussion, Delphi expert consultation and pre-survey. From February to April 2023, the data were collected from a convenient sample of 512 nursing students enrolled in five medical universities in China to conduct exploratory factor analysis and confirmatory factor analysis for validity testing. In addition, reliability analysis was conducted by calculating Cronbach's alpha coefficients, split-half reliability and test-retest reliability. The nursing students' responses were evaluated using a five-point Likert scale. RESULTS: The Hidden Curriculum Assessment Scale in Nursing Education (HCAS-NE) was formulated, consisting of 4 dimensions and 35 items. Exploratory factor analysis extracted four factors, with a cumulative variance contribution rate of 66.863 % and confirmatory factor analysis indicated that the fit indices values of the scale structure model met the criteria for an ideal level. the Cronbach's α coefficient of the scale was 0.965, the Guttman split-half was 0.853 and the test-retest reliability was 0.967. CONCLUSION: This study demonstrated that the Hidden Curriculum Assessment Scale in Nursing Education (HCAS-NE) has ideal reliability and validity, which provides a valid and reliable tool for identifying and assessing the hidden curriculum in nursing education.

Core competencies among nurses engaged in pallative care: A scoping review.

AIM: To synthesize available evidence about core competencies for nurses engaged in palliative care. DESIGN: A scoping review conducted according to the framework from Joanna Briggs Institute. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist was adopted to report this scoping review. The PubMed, Web of Science, Embase, ScienceDriect, CNKI, WangFang, VIP and Sinomed databases were used to systematically search for published studies from their inception to December 2023. Two researchers independently screened and selected relevant studies and performed the data charting. RESULTS: Twenty-six studies were included in this scoping review. Among these, 14 studies identified core competency assessment instruments among nurses engaged in palliative care, with the Palliative Care Core Competence Questionnaire was used most frequently; 13 studies investigated the status of core competencies of nurses engaged in palliative care, the majority of included studies indicated that nurse's core competencies were at moderate levels; 11 studies explored the factors influencing the core competencies of the nurses engaged in palliative care, which were classified as sociodemographic-related factors, palliative care education-related factors, death attitude, palliative care practice-related experience and others. CONCLUSION: This scoping review offers a comprehensive overview of the current landscape of core competencies among nurses in palliative care. Findings suggested that the clinical nursing leaders need to develop tailored strategies and interventions to address specific factors and promote the continuous development of nurses' competencies in palliative care. RELEVANCE TO CLINICAL PRACTICE: Core competency assessment instruments equip nurses and healthcare organizations with a range of validated tools for evaluating their proficiency in palliative care. Targeted core competency enhancement programmes need to be developed to foster a nursing workforce better equipped to improve the quality of life of end-of-life patients and their families. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Cross-cultural adaptation and psychometric validation of point-of-care outcome assessment tools in Chinese palliative care clinical practice.

BACKGROUND: A standardized national approach to routinely assessing palliative care patients helps improve patient outcomes. However, a quality improvement program-based on person centered outcomes within palliative care is lacking in Mainland China. The well-established Australian Palliative Care Outcome Collaboration (PCOC) national model improves palliative care quality. This study aimed to culturally adapt and validate three measures that form part of the PCOC program for palliative care clinical practice in China: The PCOC Symptom Assessment Scale (PCOC SAS), Palliative Care Problem Severity Scale (PCPSS), Palliative Care Phase. METHODS: A study was conducted on cross-cultural adaptation and validation of PCOC SAS, PCPSS and Palliative Care Phase, involving translation methods, cognitive interviewing, and psychometric testing through paired assessments. RESULTS: Cross-cultural adaptation highlighted the need to strengthen the link between the patient's care plan and the outcome measures to improve outcomes, and the concept of distress in PCOC SAS. Analysis of 368 paired assessments (n = 135 inpatients, 22 clinicians) demonstrated that the PCOC SAS and PCPSS had good and acceptable coherence (Cronbach's a = 0.85, 0.75 respectively). Palliative Care Phase detected patients' urgent needs. PCOC SAS and PCPSS showed fair discriminant and concurrent validity. Inter-rater reliability was fair for Palliative Care Phase (k = 0.31) and PCPSS (k = 0.23-0.30), except for PCPSS-pain, which was moderate (k = 0.53). CONCLUSIONS: The Chinese version of PCOC SAS, PCPSS, and Palliative Care Phase can be used to assess outcomes as part of routine clinical practice in Mainland China. Comprehensive clinical education regarding the assessment tools is necessary to help improve the inter-rater reliability.

Translation and validation of the Chinese version of Palliative Care Self-Efficacy Scale.

OBJECTIVES: Accurately assessing the self-efficacy levels of palliative care professionals' is crucial, as low levels of self-efficacy may contribute to the suboptimal provision of palliative care. However, there is currently lacking a reliable and valid instrument for evaluating the self-efficacy of palliative care practitioners in China. Therefore, this study aimed to translate, adapt, and validate the Palliative Care Self-Efficacy Scale (PCSS) among Chinese palliative care professionals. METHODS: This study involved the translation and cross-cultural adaptation of the PCSS, and the evaluation of its psychometric properties through testing for homogeneity, content validity, construct validity, known-groups validity, and reliability. RESULTS: A total of 493 palliative care professionals participated in this study. The results showed the critical ratio value of each item was >3 (p < 0.01), and the corrected item-total correlation coefficients of all items ranged from 0.733 to 0.818, indicating a good homogeneity of the items with the scale. Additionally, the scale was shown to have good validity, with item-level content validity index ranged from 0.857 to 1.000, and scale-level content validity index/Ave was 0.956. The exploratory factor analysis and confirmatory factor analysis (CFA) confirmed the 2-factor structure of the Chinese version of PCSS (C-PCSS), explaining 74.19% of the variance. CFA verified that the 2-factor model had a satisfactory model fit, with χ2/df = 2.724, RMSEA = 0.084, GFI = 0.916, CFI = 0.967, and TLI = 0.952. The known-groups validity of C-PCSS was demonstrated good with its sensitive in differentiating levels of self-efficacy between professionals with less than 1 year of palliative care experience (p < 0.001) or without palliative care training (p = 0.014) and their counterparts. Furthermore, the C-PCSS also exhibited an excellent internal consistency, with the Cronbach's α for the total scale of 0.943. SIGNIFICANCE OF RESULTS: The findings from this study affirmed good validity and reliability of the C-PCSS. It can be emerged as a valuable and reliable instrument for assessing the self-efficacy levels of palliative care professionals in China.

Recent Progress in Two-Dimensional Material Exfoliation Technology and Enlightenment for Geological Sciences.

Mechanical exfoliation technology is vital for the development of two-dimensional (2D) materials. This technology has also facilitated the verification of the performance of electronic and optical devices made from 2D materials. In this Perspective, we provide an overview of exfoliation techniques and highlight key physical properties. Additionally, we explored the chemical instability of certain 2D materials and proposed practical solutions to enhance their stability. Furthermore, we discuss the advantages of suspended 2D materials, which demonstrate improved compatibility and properties compared to nonsuspended materials. A particularly intriguing aspect of this Perspective is the exploration of the similarities between the Earth's crust and 2D materials, offering insights into the formation mechanisms of geological phenomena. In this context, 2D materials may serve as simulators for studying geological processes. We hope that this Perspective stimulates further research into exfoliation technology and the physical/chemical properties of 2D materials while providing new inspiration for earth science investigations.

Effects of the mini-clinical evaluation exercise teaching mode based on nurse-faculty cooperation in Fundamentals of Nursing course: A quasi-experimental study.

Objectives: This study aimed to explore the effects of the mini-clinical evaluation exercise (mini-CEX) teaching model based on nurse-faculty collaboration in Fundamentals of Nursing course. Methods: A quasi-experimental design was conducted. A total of 111 nursing students of two parallel classes were recruited from a nursing college in Guilin, China from February to December 2022, and allocated to the intervention group (n = 56) and control group (n = 55). The intervention group received a mini-CEX teaching model based on nurse-faculty collaboration, the teaching-learning process included scenario creation (10 min), inquiry-based learning (30 min), case report (30 min), scenario simulation exercise (40 min), and effectiveness evaluation (10 min). While the control group received conventional teaching method. All students were invited to complete the College Classroom Climate Assessment Scale (CCCA) and the Chinese version of the Competency Inventory for Nursing Students (CINS-CV) before and after the intervention. Course achievement of students was evaluated. After the intervention, the intervention group was asked an open-ended question to explore the difficulties or challenges they had encountered. Results: After intervention, the CCCA score (208.36 ± 23.25 vs. 190.60 ± 28.83), CINS-CV score(106.95 ± 14.48 vs. 99.55 ± 14.60), the oretical exam score (83.01 ± 4.27 vs. 79.75 ± 5.45), and scenario simulation exam score (89.23 ± 3.17 vs. 81.42 ± 7.19) of intervention group were higher than those of the control group (P＜0.01). The open-ended questionnaire survey revealed that the difficulties or challenges faced by the intervention group were mainly related to case analysis, group cooperation, learning material acquisition, and teacher guidance. Conclusion: Applying the mini-CEX teaching model based on nurse-faculty collaboration could cultivate nursing students' competency, build a positive classroom climate, and improve the course achievement of students.

Exploring the telehealth readiness and its related factors among palliative care specialist nurses: a cross-sectional study in China.

BACKGROUNDS: The majority of Chinese people who are nearing the end of their lives prefer to receive home-based palliative care. Telehealth, as a new service model, has the potential to meet the increasing demand for this service, especially in remote areas with limited resources. However, nurse-led telehealth-based palliative care services are still in the pilot implementation phase. Assessing the telehealth readiness among palliative care specialist nurses and identifying associated factors is crucial to facilitate the successful implementation of telehealth services. Therefore, this study aimed to examine TH readiness and its related factors among Chinese palliative care specialist nurses. METHODS: Four hundred nine Chinese palliative care specialist nurses from 28 provinces or municipalities participated in this study between July and August 2022. The Chinese version of Telehealth Readiness Assessment Tools (TRAT-C), and Innovative Self-Efficacy Scale (ISES-C) were used to assess the degree of TH readiness and the levels of innovative self-efficacy. RESULTS: The total score of the TRAT-C was 65.31 ± 9.09, and the total score of ISES was 29.27 ± 5.78. The statistically significant factors that influenced telehealth readiness were the experience of using telehealth platforms or services, the willingness to provide telehealth to patients, and the level of nurses' innovative self-efficacy. The innovative self-efficacy is positively correlated to telehealth readiness (r = 0.482, P < 0.01). These related factors could explain 27.3% of the difference in telehealth readiness. CONCLUSION: The telehealth readiness of Chinese palliative care specialist nurses are at a moderate level. Measures such as providing incentives to promote nurses' innovation self-efficacy by nurse managers, and establishing a comprehensive telehealth training system for palliative care specialist nurses should be taken to facilitate the implementation of telehealth services in the field of palliative care.

Chirality logic gates.

The ever-growing demand for faster and more efficient data transfer and processing has brought optical computation strategies to the forefront of research in next-generation computing. Here, we report a universal computing approach with the chirality degree of freedom. By exploiting the crystal symmetry-enabled well-known chiral selection rules, we demonstrate the viability of the concept in bulk silica crystals and atomically thin semiconductors and create ultrafast (<100-fs) all-optical chirality logic gates (XNOR, NOR, AND, XOR, OR, and NAND) and a half adder. We also validate the unique advantages of chirality gates by realizing multiple gates with simultaneous operation in a single device and electrical control. Our first demonstrations of logic gates using chiral selection rules suggest that optical chirality could provide a powerful degree of freedom for future optical computing.

Biocontrol potential of Bacillus subtilis CTXW 7-6-2 against kiwifruit soft rot pathogens revealed by whole-genome sequencing and biochemical characterisation.

Soft rot causes significant economic losses in the kiwifruit industry. This study isolated strain CTXW 7-6-2 from healthy kiwifruit tissue; this was a gram-positive bacterium that produced the red pigment pulcherrimin. The phylogenetic tree based on 16S ribosomal RNA, gyrA, rpoB, and purH gene sequences identified CTXW 7-6-2 as a strain of Bacillus subtilis. CTXW 7-6-2 inhibited hyphal growth of pathogenic fungi that cause kiwifruit soft rot, namely, Botryosphaeria dothidea, Phomopsis sp., and Alternaria alternata, by 81.76, 69.80, and 32.03%, respectively. CTXW 7-6-2 caused the hyphal surface to become swollen and deformed. Volatile compounds (VOC) produced by the strain inhibited the growth of A. alternata and Phomopsis sp. by 65.74 and 54.78%, respectively. Whole-genome sequencing revealed that CTXW 7-6-2 possessed a single circular chromosome of 4,221,676 bp that contained 4,428 protein-coding genes, with a guanine and cytosine (GC) content of 43.41%. Gene functions were annotated using the National Center for Biotechnology Information (NCBI) non-redundant protein, Swiss-Prot, Kyoto Encyclopedia of Genes and Genomes, Clusters of Orthologous Groups of proteins, Gene Ontology, Pathogen-Host Interactions, Carbohydrate-Active enZYmes, and Rapid Annotations using Subsystem Technology databases, revealing non-ribosomal pathways associated with antifungal mechanisms, biofilm formation, chemotactic motility, VOC 3-hydroxy-2-butanone, cell wall-associated enzymes, and synthesis of various secondary metabolites. antiSMASH analysis predicted that CTXW 7-6-2 can produce the active substances bacillaene, bacillibactin, subtilosin A, bacilysin, and luminmide and has four gene clusters of unknown function. Quantitative real-time PCR (qRT-PCR) analysis verified that yvmC and cypX, key genes involved in the production of pulcherrimin, were highly expressed in CTXW 7-6-2. This study elucidates the mechanism by which B. subtilis strain CTXW 7-6-2 inhibits pathogenic fungi that cause kiwifruit soft rot, suggesting the benefit of further studying its antifungal active substances.

Optical Control of High-Harmonic Generation at the Atomic Thickness.

High-harmonic generation (HHG), an extreme nonlinear optical phenomenon beyond the perturbation regime, is of great significance for various potential applications, such as high-energy ultrashort pulse generation with outstanding spatiotemporal coherence. However, efficient active control of HHG is still challenging due to the weak light-matter interaction displayed by currently known materials. Here, we demonstrate optically controlled HHG in monolayer semiconductors via the engineering of interband polarization. We find that HHG can be efficiently controlled in the excitonic spectral region with modulation depths up to 95% and ultrafast response speeds of several picoseconds. Quantitative time-domain theory of the nonlinear optical susceptibilities in monolayer semiconductors further corroborates these experimental observations. Our demonstration not only offers an in-depth understanding of HHG but also provides an effective approach toward active optical devices for strong-field physics and extreme nonlinear optics.

One-Step Exfoliation Method for Plasmonic Activation of Large-Area 2D Crystals.

Advanced exfoliation techniques are crucial for exploring the intrinsic properties and applications of 2D materials. Though the recently discovered Au-enhanced exfoliation technique provides an effective strategy for the preparation of large-scale 2D crystals, the high cost of gold hinders this method from being widely adopted in industrial applications. In addition, direct Au contact could significantly quench photoluminescence (PL) emission in 2D semiconductors. It is therefore crucial to find alternative metals that can replace gold to achieve efficient exfoliation of 2D materials. Here, the authors present a one-step Ag-assisted method that can efficiently exfoliate many large-area 2D monolayers, where the yield ratio is comparable to Au-enhanced exfoliation method. Differing from Au film, however, the surface roughness of as-prepared Ag films on SiO2 /Si substrate is much higher, which facilitates the generation of surface plasmons resulting from the nanostructures formed on the rough Ag surface. More interestingly, the strong coupling between 2D semiconductor crystals (e.g., MoS2 , MoSe2 ) and Ag film leads to a unique PL enhancement that has not been observed in other mechanical exfoliation techniques, which can be mainly attributed to enhanced light-matter interaction as a result of extended propagation of surface plasmonic polariton (SPP). This work provides a lower-cost and universal Ag-assisted exfoliation method, while at the same time offering enhanced SPP-matter interactions.

Unveiling the Degradation Mechanism of High-Temperature Superconductor Bi2Sr2CaCu2O8+δ in Water-Bearing Environments.

The physical properties of copper oxide high-temperature superconductors have been studied extensively, such as the band structure and doping effects of Bi2Sr2CaCu2O8+δ (Bi-2212). However, some chemical-related properties of these superconductors are rarely reported, such as their stability in water-bearing environments. Herein, we report experiments combined with ab initio calculations that address the effects of water in contact with Bi-2212. The evolution of Bi-2212 flakes with exposure to water for different time intervals was tested and characterized by optical microscopy (OM), atomic force microscopy (AFM), Raman spectroscopy, transmission electron microscopy (TEM), and electrical measurements. The thickness of Bi-2212 flakes is gradually decreased in water, and some thin flakes can be completely etched away after a few days. The stability of Bi-2212 in other solvents is also evaluated, including alcohol, acetone, HCl, and KOH. The morphology of Bi-2212 flakes is relatively stable in organic solvents. However, the flakes are etched relatively quick in HCl and KOH, especially in an acidic environment. Our results imply that hydrogen ions are primarily responsible for the deterioration of their properties. Both TEM and calculation results demonstrate that the atoms in the Bi-O plane are relatively stable when compared to the inner atoms in Sr-O, Ca-O, and Cu-O planes. This work contributes toward understanding the chemical stability of a Bi-2212 superconducting device in environmental medium, which is important for both fundamental studies and practical applications of copper oxide high-temperature superconductors.

Coherent modulation of chiral nonlinear optics with crystal symmetry.

Light modulation is of paramount importance for photonics and optoelectronics. Here we report all-optical coherent modulation of third-harmonic generation (THG) with chiral light via the symmetry enabled polarization selectivity. The concept is experimentally validated in monolayer materials (MoS2) with modulation depth approaching ~100%, ultra-fast modulation speed (<~130 fs), and wavelength-independence features. Moreover, the power and polarization of the incident optical beams can be used to tune the output chirality and modulation performance. Major performance of our demonstration reaches the fundamental limits of optical modulation: near-unity modulation depth, instantaneous speed (ultra-fast coherent interaction), compact footprint (atomic thickness), and unlimited operation bandwidth, which hold an ideal optical modulation solution for emerging and future nonlinear optical applications (e.g., interconnection, imaging, computing, and quantum technologies).

Inducing Strong Light-Matter Coupling and Optical Anisotropy in Monolayer MoS2 with High Refractive Index Nanowire.

Mixed-dimensional heterostructures combine the merits of materials of different dimensions; therefore, they represent an advantageous scenario for numerous technological advances. Such an approach can be exploited to tune the physical properties of two-dimensional (2D) layered materials to create unprecedented possibilities for anisotropic and high-performance photonic and optoelectronic devices. Here, we report a new strategy to engineer the light-matter interaction and symmetry of monolayer MoS2 by integrating it with one-dimensional (1D) AlGaAs nanowire (NW). Our results show that the photoluminescence (PL) intensity of MoS2 increases strongly in the mixed-dimensional structure because of electromagnetic field confinement in the 1D high refractive index semiconducting NW. Interestingly, the 1D NW breaks the 3-fold rotational symmetry of MoS2, which leads to a strong optical anisotropy of up to ∼60%. Our mixed-dimensional heterostructure-based phototransistors benefit from this and exhibit an improved optoelectronic device performance with marked anisotropic photoresponse behavior. Compared with bare MoS2 devices, our MoS2/NW devices show ∼5 times enhanced detectivity and ∼3 times higher photoresponsivity. Our results of engineering light-matter interaction and symmetry breaking provide a simple route to induce enhanced and anisotropic functionalities in 2D materials.

The impact of COVID-19 on aquaculture in China and recommended strategies for mitigating the impact.

We carried out a preliminary investigation to study the impact of COVID-19 on aquaculture in China and identify the strategies and measures that have been taken by the Chinese Government. The investigation involved questionnaire surveys designed for all stakeholders along the industrial chain, including grow-out farmers, seed producers, fish processors, fish traders, and feed companies engaged in the catfish sector in Hubei Province and the tilapia sector in Guangdong Province during the strict period of control and after these control measures were lifted. We also attempted to summarize the government interventions and measures taken by different stakeholders along the value chain to minimize the damage caused by COVID-19 and support the recovery of different sectors in the aquaculture industry. We found that due to delayed harvesting, fish stocks were held-up in ponds and normal farming was interrupted. Farmers and traders were more severely impacted by the pandemic than other sectors. Furthermore, a series of strategies and measures are recommended to cope with the pandemic and other similar risks in the future. We expect that this study will provide good evidence for international societies to support the aquaculture industry in minimizing the impact of the pandemic and the rapid recovery of the industry in the post-pandemic period.

Sensitivity Testing of Natural Antifungal Agents on Fusarium fujikuroi to Investigate the Potential for Sustainable Control of Kiwifruit Leaf Spot Disease.

Kiwifruit is a nutritious and economically important fruit that is widely cultivated in China. In 2021, leaf spot disease of kiwifruit was discovered in the main kiwifruit-producing area of Xifeng County, Guizhou Province, China. Leaf spot disease weakens plant photosynthesis and reduces nutrient synthesis, thereby affecting plant growth. We studied the morphological characteristics and performed a combined analysis of EF-1α, RPB2, and TUB2 genes of Fusarium fujikuroi, a fungus associated with leaf spot disease. The pathogenicity of F. fujikuroi followed Koch's hypothesis, confirming that this fungus is the cause of kiwifruit leaf spot disease. The sensitivity of seven natural antifungal agents against F. fujikuroi was measured using the mycelial growth rate method. Honokiol, cinnamaldehyde, and osthol showed good antifungal effects against F. fujikuroi, with EC50 values of 18.50, 64.60, and 64.86 µg/mL, respectively. The regression coefficient of cinnamaldehyde was the largest at 2.23, while that of honokiol was the smallest at 0.408. Fusarium fujikuroi was the most sensitive to cinnamaldehyde.

Probing Electronic States in Monolayer Semiconductors through Static and Transient Third-Harmonic Spectroscopies.

Electronic states and their dynamics are of critical importance for electronic and optoelectronic applications. Here, various relevant electronic states in monolayer MoS2 , such as multiple excitonic Rydberg states and free-particle energy bands are probed with a high relative contrast of up to ≥200 via broadband (from ≈1.79 to 3.10 eV) static third-harmonic spectroscopy (THS), which is further supported by theoretical calculations. Moreover, transient THS is introduced to demonstrate that third-harmonic generation can be all-optically modulated with a modulation depth exceeding ≈94% at ≈2.18 eV, providing direct evidence of dominant carrier relaxation processes associated with carrier-exciton and carrier-phonon interactions. The results indicate that static and transient THS are not only promising techniques for the characterization of monolayer semiconductors and their heterostructures, but also a potential platform for disruptive photonic and optoelectronic applications, including all-optical modulation and imaging.

Symptom trajectories for palliative care inpatients with and without hyperactive delirium in the last week of life.

AIMS: Hyperactive delirium (HD) is a common and distressing symptom among palliative care patients. This study aimed to describe the characteristics of HD and associated symptoms among palliative care inpatients and evaluate relationships between HD development and symptom trajectories in this population. DESIGN: A retrospective study was conducted. METHODS: A retrospective review of medical records was conducted for all patients who died in a large Australian specialist palliative care unit between 1 January and 31 December 2019. Patients were assessed daily using the Symptoms Assessment Scale (SAS) and Palliative Care Problem Severity Scale (PCPSS). Multilevel models were used to estimate the differences in symptoms trajectories in the last 7 days of life between the two groups. RESULTS: Of the 501 included patients, 64.5% (323) had an episode of HD. For 30% (95) of patients, HD occurred prior to admission. Compared with patients without HD, those with HD had significantly higher odds ratios (ORs) for four of the seven SAS symptoms (sleep problems, appetite, fatigue and pain; OR range: 1.94-4.48, p < .05), and all four PCPSS items (OR range: 2.00-3.00, p < .05) in the last week of life. CONCLUSIONS: Palliative care inpatients commonly experience HD in their last week of life. There are higher levels of symptom distress, complexity, psychological concerns and family/carer concerns among patients with HD compared with those without HD. IMPACT: The high prevalence of HD, and its association with higher levels of symptom distress, highlights the importance of routine screening and optimal management for HD among palliative care patients. Given the widely recognized challenges facing palliative care professionals in assessment and management of delirium, provision of relevant training among these professionals is recommended.

Tunable Quantum Tunneling through a Graphene/Bi2Se3 Heterointerface for the Hybrid Photodetection Mechanism.

Graphene-based van der Waals heterostructures are promising building blocks for broadband photodetection because of the gapless nature of graphene. However, their performance is mostly limited by the inevitable trade-off between low dark current and photocurrent generation. Here, we demonstrate a hybrid photodetection mode based on the photogating effect coupled with the photovoltaic effect via tunable quantum tunneling through the unique graphene/Bi2Se3 heterointerface. The tunneling junction formed between the semimetallic graphene and the topologically insulating Bi2Se3 exhibits asymmetric rectifying and hysteretic current-voltage characteristics, which significantly suppresses the dark current and enhances the photocurrent. The photocurrent-to-dark current ratio increases by about a factor of 10 with the electrical tuning of tunneling resistance for efficient light detection covering the major photonic spectral band from the visible to the mid-infrared ranges. Our findings provide a novel concept of using tunable quantum tunneling for highly sensitive broadband photodetection in mixed-dimensional van der Waals heterostructures.