https://www.selleckchem.com/products/bgj398-nvp-bgj398.html 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. 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 acc