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1. Utilizing a case-based approach, participants will self-report an understanding of the historical context of cardiopulmonary resuscitation, do-not-attempt-resuscitation (DNAR) orders, and unilateral do-not-attempt-resuscitation (UDNAR) orders. 2. Utilizing a case-based approach, participants will self report a knowledge of the ethical principles involved with UDNAR orders as well as concerns for unequal utilization of UDNAR orders for underserved populations. The principle of non-maleficence calls upon providers to not offer treatments we believe to be futile or non-beneficial. In recent years, this concept has led to the rise of so-called Unilateral Do-Not-Attempt-Resuscitation (UDNAR) orders. However, emerging evidence suggests that UDNAR orders may be disproportionately affecting underserved communities and may drive distrust between these communities and medical organizations. In serious illness communication, discussions around code status are common and typically occur in the context of end of life care. Traditionally, an individual's default code status has been understood to be "Full Code" and that cardiopulmonary resuscitation could only be withheld at the explicit request of a patient or their surrogate decision maker. However, providing full code measures for a patient dying of an irreversible process can cause a great deal of moral distress to clinicians. In the last 10-15 years the idea of a unilateral do-not-attempt resuscitation (UDNAR) order has gained increasing acceptance, recognizing that clinicians can identify when the aggressive treatment of a cardiopulmonary arrest provides little to no benefit to the terminally ill. More recently, however, controversies about when and how to invoke UNDAR orders have arisen. During the COVID pandemic, concerns were raised about inappropriate blanket DNAR orders for patient's severely ill with COVID, and recent studies have suggested that vulnerable populations may be inordinately subject to UDNAR orders in the hospital. In this case-based discussion, we will review the historical context of both cardiopulmonary resuscitation and do-not-attempt resuscitation (DNAR) orders; discuss the rise of UDNAR orders; outline the ethical argument for and against UDNAR orders; and explore recent work involving disparities in its application to patients at the end of life. Ethical / Legal Aspects of Care; Diversity, Equity, Inclusion, Belonging, Justice [ABSTRACT FROM AUTHOR]

Digital transformation in higher education, especially after COVID-19, is seen as inevitable. This research explores digital transformation's maturity and challenges within the education enterprise. The significance of this study stems from the critical role digital transformation and higher education play in today's digital economy, and digital learning, especially with the impact of COVID-19. This study proposes a new model to measure digital transformation maturity assessment in the education enterprise, based on Deloitte's 2019 digital transformation assessment model, and Petkovic et al.'s [2014. Cloud Computing Support to University Business Processes in External Collaboration." Acta Polytechnica Hungarica 11 (3): 181–200] mega and major higher education process mapping. The study triangulates the findings of multiple research instruments, including survey, interviews, case study, and direct observation. The research findings show a gap between digital transformation's maturity perception, and core requirements. A stronger focus on enabling processes, and a lack of wholistic vision, digital transformation competency, and data structure were among the leading challenges in digital transformation. [ABSTRACT FROM AUTHOR]

N‐type conjugated polymers as the semiconducting component of organic electrochemical transistors (OECTs) are still undeveloped with respect to their p‐type counterparts. Herein, we report two rigid n‐type conjugated polymers bearing oligo(ethylene glycol) (OEG) side chains, PgNaN and PgNgN, which demonstrated an essentially torsion‐free π‐conjugated backbone. The planarity and electron‐deficient rigid structures enable the resulting polymers to achieve high electron mobility in an OECT device of up to the 10−3 cm2 V−1 s−1 range, with a deep‐lying LUMO energy level lower than −4.0 eV. Prominently, the polymers exhibited a high device performance with a maximum dimensionally normalized transconductance of 0.212 S cm−1 and the product of charge‐carrier mobility μ and volumetric capacitance C* of 0.662±0.113 F cm−1 V−1 s−1, which are among the highest in n‐type conjugated polymers reported to date. Moreover, the polymers are synthesized via a metal‐free aldol‐condensation polymerization, which is beneficial to their application in bioelectronics. [ABSTRACT FROM AUTHOR]

N‐type conjugated polymers as the semiconducting component of organic electrochemical transistors (OECTs) are still undeveloped with respect to their p‐type counterparts. Herein, we report two rigid n‐type conjugated polymers bearing oligo(ethylene glycol) (OEG) side chains, PgNaN and PgNgN, which demonstrated an essentially torsion‐free π‐conjugated backbone. The planarity and electron‐deficient rigid structures enable the resulting polymers to achieve high electron mobility in an OECT device of up to the 10−3 cm2 V−1 s−1 range, with a deep‐lying LUMO energy level lower than −4.0 eV. Prominently, the polymers exhibited a high device performance with a maximum dimensionally normalized transconductance of 0.212 S cm−1 and the product of charge‐carrier mobility μ and volumetric capacitance C* of 0.662±0.113 F cm−1 V−1 s−1, which are among the highest in n‐type conjugated polymers reported to date. Moreover, the polymers are synthesized via a metal‐free aldol‐condensation polymerization, which is beneficial to their application in bioelectronics. [ABSTRACT FROM AUTHOR]

Cholesterol is a crucial component of biological membranes and can interact with other membrane components through hydrogen bonding. NMR spectroscopy has been used previously to investigate this bonding, however this study represents the first 17O NMR spectroscopy study of isotopically enriched cholesterol. We demonstrate the 17O chemical shift is dependent on hydrogen bonding, providing a novel method for the study of cholesterol in bilayers. [ABSTRACT FROM AUTHOR]

Outcomes: 1. Understand current technologies, eligibility, and national and international societal guidelines surrounding posthumous reproduction, with a focus on how palliative care providers may interface with patients and/or families exploring this intervention 2. Investigate controversies surrounding posthumous reproduction, including current ethical and legal frameworks With the growing availability, advancing technology, and improved insurance coverage of assisted reproductive technologies (ARTs), more patients are considering available options for reproduction and more medical centers are offering fertility services. Posthumous reproduction is defined as the birth of a child after the death of a parent. This process may involve gamete (sperm or oocyte) retrieval, fertilization, and/or embryo creation either before or after a parent's death. Current American Society of Clinical Oncology guidelines recommend that all patients of childbearing age be given information about fertility preservation, but no guidelines exist on how this information should be framed in the context of a patient's prognosis, especially in the setting of a known life-limiting condition. With the expansion of palliative care programs nationwide and the increased reach of palliative medicine into a broad range of diagnoses, providers will encounter more patients of childbearing age who may be exploring reproductive options. How can palliative care practitioners explore reproductive options with patients who have a likely terminal condition? First, it is important to understand the current available ARTs, financial and legal considerations, and the ability to explore potential spiritual and/or existential contexts from which discussions of posthumous reproduction may arise. Second, it is important for palliative care teams to understand the controversial ethical landscape that patients, families, and providers from a variety of specialties may encounter. In this concurrent session, palliative medicine and ob-gyn providers will review case studies, clinical literature, national guidelines, and expert opinions to share key discussion points and challenges in supporting patients of childbearing age with life-limiting conditions. To conclude, we will provide a proposed communication roadmap to use when exploring this topic in a palliative care interaction. [ABSTRACT FROM AUTHOR]

Requests for perimortem gamete procurement (PGP) typically arise by a surrogate decision maker after the unexpected death or incapacitation of a reproductive-aged individual. Palliative care clinicians should have a working knowledge of the medical, ethical, and practical considerations pertaining to such requests. In this paper, we describe a case in which the PGP request originated from an incapacitated patient's parents. We review the technologies associated with PGP and posthumous assisted reproduction (PAR) and discuss the ethical and legal issues involved in such cases, including recent position statements from national and international reproductive health groups. Finally, we provider readers with a stepwise approach for considering requests for PGP. [ABSTRACT FROM AUTHOR]

Addressing implantable cardiac devices in hospital policies on withdrawal of life-sustaining interventions can support clinicians and prevent arbitrary decisionmaking. Bioethicists can do the following: ^#8226; Educate providers on the ethical consensus that pacemaker deactivation is not considered euthanasia. • Work hard to resolve concerns of resistant clinicians. • Explicitly include pacemakers, implantable cardioverter-defibrillators, and left ventricular assist devices. [ABSTRACT FROM AUTHOR]

Outcomes 1. Define potentially unsafe low-evidence therapies (PULETs) and differentiate them from evidence-informed complementary and alternative therapies 2. Review the ethical and legal issues that may potentially arise in the care of patients who pursue PULETs 3. Discuss a stepwise approach to empathetic communication with patients who pursue PULETs, with an emphasis on humble inquiry and nonabandonment Palliative care providers regularly care for patients with a serious illness, many of whom are engaging in the use of complementary and alternative medicine (CAM) either alone or along with traditional medical therapies. A subset of these patients may be engaging in therapies that not only have little or no evidence for efficacy but also carry significant potential risks to their health and well-being. However, these therapies may carry a great deal of significance for the patient and family for whom conventional medicine has failed or is otherwise deemed untenable. Thus, dismissing such therapies as "quackery" risks alienating patients and damaging or even severing a therapeutic relationship. When faced with patients who are engaging in potentially unsafe low-evidence therapies (PULETs), providers themselves may experience a great deal of moral distress when deciding how to balance supporting the hope PULETs may represent with the principles of nonmaleficence and autonomy. In this case-based concurrent session, palliative care and CAM providers will review the definition of PULETs and distinguish them from the majority of CAM therapies. Drawing upon existing writings in the CAM literature, participants will then review a framework to evaluate the relative risk/benefit ratio of such therapies. A review of the ethical and legal aspects of care will then take place, including reporting mechanisms when frank fraud or abuse is suspected. Finally, using existing principles and tools in emotion-based communication, participants will engage in an interactive exercise to apply these tools in a stepwise fashion to foster continued collaboration and care for patients who engage in PULETs. Of note, these small group activities can be adapted for either the in-person or virtual environment. [ABSTRACT FROM AUTHOR]

1. Understand the role acetylcholine may have in acute and chronic pain. 2. Consider potential mechanisms through which rivastigmine might impact pain in individuals with cognitive impairment. Rivastigmine has become one of the most commonly prescribed medications for multiple forms of dementia. We present a case of unexpected and rapid improvement in chronic pain upon rivastigmine initiation during a hospital admission for delirium. It is important to consider cholinergic mechanisms in addressing refractory pain as well as the interactions between chronic pain and cognitive impairment. Cholinergic deficit is a common component of both cognitive impairment and acute pain. Neostigmine has a well-documented history of use as adjunctive postoperative analgesia. Rivastigmine has become one of the most commonly prescribed medications for multiple forms of dementia. Little has been reported, however, about potential analgesic properties of rivastigmine, particularly in the setting of chronic pain. We present the case of a 76-year-old male with a history of cognitive impairment and chronic low back pain refractory to multiple therapeutic agents. After a traumatic fall with fracture, he experienced a significant decline in his cognitive function and worsening of his pain. After repeated episodes of delirium, aggression and suicidal ideation secondary to unremitting pain, the patient experienced an unexpected and rapid relief in pain and improved mentation upon initiation of a rivastigmine patch during his admission. In the 8 months following discharge, the patient demonstrated sustained improvement of his chronic low back pain with minimal additional pharmacotherapy and no further episodes of delirium requiring hospitalization. -Review the roles of acetylcholine in acute and chronic pain. -Consider potential mechanisms through which rivastigmine might impact pain in individuals with cognitive impairment. -Discuss recent literature regarding the interdependent relationship between chronic pain and cognitive impairment. Emergencies / Refractory Symptom Management /Disease specific management [ABSTRACT FROM AUTHOR]

Research on information systems development methodologies (ISDM) adoption has been widely undertaken to highlight the experience of developed countries. Studies concerned with the status of ISDM in developing economies including the factors that influence and motivate their use, current trends, difficulties, and barriers to adoption are lacking. This paper explores these issues in a developing economy, namely Oman, and proposes an ISDM adoption decision model using analytical hierarchy process analysis informed by a survey and Delphi consultation. The findings from the survey reveal a lack of knowledge of ISDM amongst Omani Information Systems developers and the reliance on ad-hoc software development methods. Conversely, analyzed data reveals a trend whereby a majority of Omani organizations are gradually moving towards increased ISDM adoption and deployment. This has motivated the development of an adoption decision model to assist software companies to select the right ISDM adapted to their organizational needs in Oman. This model has a generic dimension and can be adapted to other socio-organizational contexts. [ABSTRACT FROM AUTHOR]

Background: For the better part of 100 years, acetaminophen (or paracetamol as it is known outside of the United States) has been a common first-line analgesic in pediatrics and is typically well tolerated with minimal side effects. Its use as an anti-pyretic is also well-documented and thus it is used broadly for symptom control in the general pediatric population. Discussion: In pediatric palliative care, acetaminophen is also used as an adjuvant to opioid therapy for pain as well as an anti-pyretic. For many pediatric patients near end-of-life, however, the ability to tolerate oral intake is diminished and rectal suppository administration can be distressing or contraindicated as in the setting of neutropenia, thus limiting use of acetaminophen by its usual routes. In Europe and Australia, an intravenous formulation of acetaminophen has been used for many years and has only recently become available in the United States. Conclusion: Here, we describe a case using intravenous acetaminophen in a pediatric patient at the end of life. [ABSTRACT FROM AUTHOR]

The article focuses on perimortem gamete procurement (PGP) requests and the ethical, legal, and medical considerations surrounding these requests in the context of posthumous assisted reproduction (PAR). Topics covered include physiological considerations for PGP, ethical concerns regarding autonomy and decision-making, and guidelines for action in the absence of governmental regulations.

The article discusses the definition and diagnosis of existential suffering experienced by patients under palliative care. Topics covered include common identification tools for determining existential suffering, the difference between existential and spiritual suffering, the need for clinicians to listen for existential cues in patients with serious illness and the clinical manifestation of different existential domains including mortality, freedom and isolation.

The article discusses clinical management issues relevant to existential suffering of patients under palliative care. Topics covered include the importance for clinicians to avoid focusing their clinical assessment solely on physical symptoms, psychotherapeutic modalities that can help alleviate existential suffering including meaning-centered group and individual psychotherapy, dignity therapy and supportive expressive group therapy and the importance of emphatic presence.

The true structure of alternating conjugated polymers—the state‐of‐the‐art materials for many organic electronics—often deviates from the idealized picture. Homocoupling defects are in fact inherent to the widely used cross‐coupling polymerization methods. Nevertheless, many polymers still perform excellently in the envisaged applications, which raises the question if one should really care about these imperfections. This article looks at the relevance of chemical precision (and lack thereof) in conjugated polymers covering the entire spectrum from the molecular scale, to the micro and mesostructure, up to the device level. The different types of polymerization errors for the alkoxylated variant of the benchmark (semi)crystalline polymer poly[2,5‐bis(3‐tetradecylthiophen‐2‐yl)thieno[3,2‐b]thiophene (PBTTT) are identified, visualized, and quantified and a general strategy to avoid homocoupling is introduced. Through a combination of experiments and supported by simulations, it is shown that these coupling defects hinder fullerene intercalation and limit device performance as compared to the homocoupling‐free analog. This clearly demonstrates that structural defects do matter and should be generally avoided, in particular when the geometrical regularity of the polymer is essential. These insights likely go beyond the specific PBTTT derivatives studied here and are of general relevance for the wider organic electronics field. [ABSTRACT FROM AUTHOR]

Pain is a common symptom in pediatric patients with cancer, and most patients in palliative care will receive opioids. Traditional opioids have several drawbacks, including their adverse effects, inconsistent or diminishing efficacy, and limited available routes of administration. Buprenorphine is an attractive option for pain management because of its safety profile, unique pharmacology, and availability in transdermal, buccal, parenteral, and sublingual (SL) dosage forms. Unfortunately, data supporting the use of buprenorphine in pediatric pain patients, particularly SL buprenorphine, are lacking. This case report describes the feasibility of SL buprenorphine use in pediatric patients with complex cancer-related pain. [ABSTRACT FROM AUTHOR]

The development of sensor electrode materials for the detection of metabolites will enable point‐of‐care diagnostic devices for the monitoring and treatment of metabolic diseases such as diabetes. Current state‐of‐the‐art glucose sensing electrodes employ the organic salt tetrathiafulvene tetracyanoquinodimethane (TTF TCNQ) to receive electrons directly from enzymatic reactions of glucose. However, TTF TCNQ is insoluble in most solvents, making it challenging to deposit high‐quality electrodes. Furthermore, its hydrophobicity hinders its interface with aqueous solutions in physiological environments. To overcome these issues, TCNQ derivatives are introduced into an electron‐rich and hydrophilic conjugated polymer. Thus, a polymeric electrode is demonstrated that is easily solution processible and can undergo volumetric direct electron transfer with glucose reactions throughout its bulk. This study further elucidates the electron transfer mechanism during chemical doping and metabolite sensing reactions to inform general design rules for this new class of glucose sensing materials. [ABSTRACT FROM AUTHOR]

Fullerenes have formed an integral part of high performance organic solar cells over the last 20 years, however their inherent limitations in terms of synthetic flexibility, cost and stability have acted as a motivation to develop replacements; the so-called non-fullerene electron acceptors. A rapid evolution of such materials has taken place over the last few years, yielding a number of promising candidates that can exceed the device performance of fullerenes and provide opportunities to improve upon the stability and processability of organic solar cells. In this review we explore the structure–property relationships of a library of non-fullerene acceptors, highlighting the important chemical modifications that have led to progress in the field and provide an outlook for future innovations in electron acceptors for use in organic photovoltaics. [ABSTRACT FROM AUTHOR]

Outcomes 1. Review current technologies, eligibility, and national and international societal guidelines surrounding posthumous reproduction, with a specific focus on how palliative care providers may interface with patients or families exploring this intervention 2. Explore controversies surrounding posthumous reproduction, including historic and current ethical and legal frameworks 3. Discuss a proposed communication roadmap for palliative care providers to use when initiating or continuing a discussion about posthumous reproduction with patients and families, in collaboration with multidisciplinary teams With the growing availability, advancing technology, and improved insurance coverage of assisted reproductive technologies (ARTs), more patients are considering available options for assisted reproduction, and more medical centers are offering fertility services. Posthumous reproduction is defined as the birth of a child after the death of a parent. This process may involve gamete (sperm or oocyte) retrieval, fertilization, or embryo creation either before or after a parent's death. Current American Society of Clinical Oncology guidelines recommend that all patients of childbearing age be given information about fertility preservation, but no such guidelines exist on how this information should be framed in the context of a patient's prognosis, especially in the setting of a known life-limiting condition. With the expansion of palliative care programs nationwide and the increased reach of palliative medicine into a broad range of diagnoses, providers will encounter more terminally ill patients of childbearing age who may be exploring reproductive options. How can palliative care providers explore reproductive options with patients who have an expected terminal condition? First, it is important to understand the current available ARTs, including financial and legal considerations. Just as important is the ability to explore potential spiritual or existential contexts from which discussions of posthumous reproduction may arise. Next, it is important for palliative care teams to understand the controversial ethical landscape that patients, families, and providers from a variety of specialties may encounter. In this concurrent session, palliative medicine and reproductive health providers will review case studies, clinical literature, national guidelines, and expert opinions to share key discussion points and challenges in supporting patients of childbearing age with expected terminal conditions. To conclude our session, we will provide a proposed communication roadmap to use when exploring this topic in a palliative care interaction. [ABSTRACT FROM AUTHOR]

The development of organic electrochemical transistors (OECTs) capable of maintaining their high amplification, fast transient speed, and operational stability in harsh environments will advance the growth of next‐generation wearable and biological electronics. In this study, a high‐performance solid‐state OECT (SSOECT) is successfully demonstrated, showing a recorded high transconductance of 220 ± 59 S cm−1, ultrafast device speed of ≈10 kHz with excellent operational stability over 10 000 switching cycles, and thermally stable under a wide temperature range from −50 to 110 °C. The developed SSOECTs are successfully used to detect low‐amplitude physiological signals, showing a high signal‐to‐noise‐ratio of 32.5 ± 2.1 dB. For the first time, the amplifying power of these SSOECTs is also retained and reliably shown to collect high‐quality electrophysiological signals even under harsh temperatures (−50 and 110 °C). The demonstration of high‐performing SSOECTs and its application in harsh environment are core steps toward their implementation in next‐generation wearable electronics and bioelectronics. [ABSTRACT FROM AUTHOR]

The article presents a study which explores that two-dimensional metal-organic frameworks for ultraflexible electrochemical transistors with high transconductance and fast response speeds. It mentions that electrochemical transistors (ECTs) have shown broad applications in bioelectronics and neuromorphic devices due to their high transconductance, low working voltage, and versatile device design.

The development of organic electrochemical transistors (OECTs) capable of maintaining their high amplification, fast transient speed, and operational stability in harsh environments will advance the growth of next‐generation wearable and biological electronics. In this study, a high‐performance solid‐state OECT (SSOECT) is successfully demonstrated, showing a recorded high transconductance of 220 ± 59 S cm−1, ultrafast device speed of ≈10 kHz with excellent operational stability over 10 000 switching cycles, and thermally stable under a wide temperature range from −50 to 110 °C. The developed SSOECTs are successfully used to detect low‐amplitude physiological signals, showing a high signal‐to‐noise‐ratio of 32.5 ± 2.1 dB. For the first time, the amplifying power of these SSOECTs is also retained and reliably shown to collect high‐quality electrophysiological signals even under harsh temperatures (−50 and 110 °C). The demonstration of high‐performing SSOECTs and its application in harsh environment are core steps toward their implementation in next‐generation wearable electronics and bioelectronics. [ABSTRACT FROM AUTHOR]

The article talks about the voluntary stopping of eating and drinking (VSED), which is defined as a competent individual deciding to stop taking hydration and nutrition with the intention of hastening death. Topics discussed include providing counseling or managing symptoms is tantamount to assisting with an immoral act; patient pursuing VSED should be prepared that coordinating ethical, legal, and psychiatric input is needed; and importance of eating and drinking with careful attention.

Complex wounds are common complications in hospice and palliative medicine (HPM), especially in patients with aggressive malignancies. Myiasis, or an infestation of maggots, is a rare but significant complication of such wounds. While uncommon in the United States, many HPM patients have multiple risk factors and comorbidities that increase their vulnerability to this condition. Currently, there are no standard diagnostic or treatment guidelines for wound myiasis. In addition, common management strategies may not be easily accessible in HPM settings. We present this case of a patient with malignant squamous cell carcinoma of the neck complicated by myiasis while in hospice, and our experience diagnosing and managing her infestation. We also reflect on special considerations for HPM patients when addressing the physical and psychological symptoms of wound myiasis. [ABSTRACT FROM AUTHOR]

Donor–acceptor (D‐A) polymers are promising materials for organic electrochemical transistors (OECTs), as they minimize detrimental faradaic side‐reactions during OECT operation, yet their steady‐state OECT performance still lags far behind their all‐donor counterparts. We report three D‐A polymers based on the diketopyrrolopyrrole unit that afford OECT performances similar to those of all‐donor polymers, hence representing a significant improvement to the previously developed D‐A copolymers. In addition to improved OECT performance, DFT simulations of the polymers and their respective hole polarons also reveal a positive correlation between hole polaron delocalization and steady‐state OECT performance, providing new insights into the design of OECT materials. Importantly, we demonstrate how polaron delocalization can be tuned directly at the molecular level by selection of the building blocks comprising the polymers' conjugated backbone, thus paving the way for the development of even higher performing OECT polymers. [ABSTRACT FROM AUTHOR]

Donor–acceptor (D‐A) polymers are promising materials for organic electrochemical transistors (OECTs), as they minimize detrimental faradaic side‐reactions during OECT operation, yet their steady‐state OECT performance still lags far behind their all‐donor counterparts. We report three D‐A polymers based on the diketopyrrolopyrrole unit that afford OECT performances similar to those of all‐donor polymers, hence representing a significant improvement to the previously developed D‐A copolymers. In addition to improved OECT performance, DFT simulations of the polymers and their respective hole polarons also reveal a positive correlation between hole polaron delocalization and steady‐state OECT performance, providing new insights into the design of OECT materials. Importantly, we demonstrate how polaron delocalization can be tuned directly at the molecular level by selection of the building blocks comprising the polymers' conjugated backbone, thus paving the way for the development of even higher performing OECT polymers. [ABSTRACT FROM AUTHOR]

1. Describe a novel mechanism by which individual cases of healthcare bias, inequity, or discrimination can be addressed by a large academic healthcare system. 2. Discuss treatment options for chronic pain in heart failure. Heart failure is a common disease seen in palliative care, and chest pain is a frequent but undertreated symptom. Opioids are an essential tool for pain management in palliative care, but that may present challenges for destination treatments (LVAD, transplant). For some patient populations, healthcare teams' own biases and the ease of propagating errors in the electronic medical record are also barriers to providing equitable care. Mr. G is a 36-year-old African American male admitted for heart failure exacerbation (EF 5%-10%). He had previously been rejected as an LVAD candidate due to psychosocial reasons and a purported history of substance use disorder (SUD). He has chronic chest pain related to his exacerbations, which was poorly controlled with opioids and non-opioid medications. The palliative care consult services (PCCS) was consulted for pain management and in chart review found evidence of new social supports and no evidence of SUD. Given concern for healthcare bias affecting his care, the PCCS consulted the healthcare equity consult service (HECS), a new interdisciplinary team created to support patients whose care may be affected by bias, inequality, or perceived discrimination. The HECS and PCCS teams were able to educate the other healthcare teams about errors propagated in the electronic medical record and improve communication expectations between the patient and his teams. He was reevaluated and deemed to be a candidate for mechanical circulatory support, and postoperatively he had improved pain management by rotating his hydromorphone to buprenorphine. Palliating acute or chronic chest pain in heart failure is challenging when patients' records have biasing and conflicting evidence. Having systems in place to identify and intervene with bias may improve patient care, pain control, and address issues of healthcare inequality. Buprenorphine is an effective tool for visceral pain control related to heart failure. [ABSTRACT FROM AUTHOR]

The author comments on an article published within the issue on the important ethical dimensions to consider when making difficult explicit rationing decisions during the COVID-19 pandemic. Topics include the focus of the national ethics conversation during the first months of the pandemic in the U.S., how methodical consideration of rationing during the COVID-19 pandemic should begin, and an important step once the distinctions between futility and scare resource allocation were considered.

Background: An interdisciplinary palliative care team began exploring evaluation tools used to assess changes in the knowledge, skills, and attitudes of learners participating in clinical learning experiences on an interdisciplinary palliative care consult service. This article will review existing evaluation tools, examine the themes that emerge, discuss their strengths and limitations, and make recommendations for continued development in the field. Methods and Findings: A literature search was performed using the MEDLINE database. Search terms included combinations of the following: interdisciplinary education, assessment/evaluation, and palliative care or palliative care assessment/test. Four hundred eighty-seven articles were captured during the initial search. Articles that focused on student readiness for interdisciplinary education and team self-assessments of current interdisciplinary collaboration practices were excluded. Nine articles were included in the review. Evaluation tools varied in terms of learner type, assessment type, and frequency. No tool was comprehensive in the assessment of knowledge, skills, and attitudes or truly interdisciplinary. Conclusions: There is a lack of comprehensive and interdisciplinary evaluation tools in the published literature. Further research should be conducted to develop a tool that meets the needs of learners in clinical experiences within an interdisciplinary service. [ABSTRACT FROM AUTHOR]

Epidemiological, preclinical, and clinical studies have suggested a role for microdose lithium in reducing Alzheimer's disease (AD) risk by modulating key mechanisms associated with AD pathology. The novel microdose lithium formulation, NP03, has disease-modifying effects in the McGill-R-Thy1-APP transgenic rat model of AD-like amyloidosis at pre-plaque stages, before frank amyloid-β (Aβ) plaque deposition, during which Aβ is primarily intraneuronal. Here, we are interested in determining whether the positive effects of microdose lithium extend into early Aβ post-plaque stages. We administered NP03 (40μg Li/kg; 1 ml/kg body weight) to McGill-R-Thy1-APP transgenic rats for 12 weeks spanning the transition phase from plaque-free to plaque-bearing. The effect of NP03 on remote working memory was assessed using the novel object recognition task. Levels of human Aβ38, Aβ40, and Aβ42 as well as levels of pro-inflammatory mediators were measured in brain-extracts and plasma using electrochemiluminescent assays. Mature Aβ plaques were visualized with a thioflavin-S staining. Vesicular acetylcholine transporter (VAChT) bouton density and levels of chemokine (C-X-C motif) ligand 1 (CXCL1), interleukin-6 (IL-6), and 4-hydroxynonenal (4-HNE) were probed using quantitative immunohistochemistry. During the early Aβ post-plaque stage, we find that NP03 rescues functional deficits in object recognition, reduces loss of cholinergic boutons in the hippocampus, reduces levels of soluble and insoluble cortical Aβ42 and reduces hippocampal Aβ plaque number. In addition, NP03 reduces markers of neuroinflammation and cellular oxidative stress. Together these results indicate that microdose lithium NP03 is effective at later stages of amyloid pathology, after appearance of Aβ plaques. [ABSTRACT FROM AUTHOR]

The article offers information on the management of ischemic limb pain (ILP). Topics discussed include ILP, intermittent claudication (IC), and critical limb ischemia (CLI). Also being discussed are the topics like peripheral arterial disease (PAD), ankle-brachial index (ABI), and congestive heart failure (CHF).