Search

Increased advance care planning was endorsed at the start of the Coronavirus disease 2019 (COVID-19) pandemic with the aim of optimizing end-of-life care. This retrospective observational cohort study explores the impact of advanced care planning on place of death. 21,962 records from patients who died during the first year of the pandemic and who had an Electronic Palliative Care Coordination System record were included. 11,913 (54%) had a documented place of death. Of these 5,339 died at home and 2,378 died in hospital. 9,971 (45%) had both a documented place of death and a preferred place of death. Of these, 7,668 (77%) died in their preferred location. Documented elements of advance care planning, such as resuscitation status and ceiling of treatment decisions, were associated with an increased likelihood of dying in the preferred location, as were the number of times the record was viewed. During the COVID-19 pandemic, advanced care planning and the use of digital care coordination systems presented an opportunity for patients and healthcare staff to personalize care and influence end-of-life experiences.

In the Arctic waterbodies are abundant and rapid thaw of permafrost is destabilizing the carbon cycle and changing hydrology. It is particularly important to quantify and accurately scale aquatic carbon emissions in arctic ecosystems. Recently available high-resolution remote sensing datasets capture the physical characteristics of arctic landscapes at unprecedented spatial resolution. We demonstrate how machine learning models can capitalize on these spatial datasets to greatly improve accuracy when scaling waterbody CO _2 and CH _4 fluxes across the YK Delta of south-west AK. We found that waterbody size and contour were strong predictors for aquatic CO _2 emissions, attributing greater than two-thirds of the influence to the scaling model. Small ponds (