Are Anatomical Gift Donors Demographically Representative of the American Aging Patient Population?

Body donation for medical education is voluntary and open to all; however, it is undetermined if the donors studied at UMass Medical School (UMMS) are demographically representative of the national patient population. If not, medical students are missing the opportunity of experiencing normal variation within the population, which may promote bias in their clinical years. This cross-sectional study compared data from the UMMS Anatomical Gift Program (AGP) with the Health and Retirement Study (HRS) population data. This study examined sex, race, ethnicity, veteran status, and sexual orientation. 5 years (n=540) of AGP data and 3 waves (n=5,037) of HRS data were examined. The results demonstrate that sex differences between the AGP and HRS populations (55% for females vs. 45% for males; p=.10) are NOT significant. A significant racial difference between populations is noted (p=.000), with 98.3% of the AGP vs. 72.7% of the HRS identifying as white. Veterans are overrepresented in the AGP (22.6% AGP vs. 9.6% HRS; p=.000). 12.3% of HRS participants report Hispanic ethnicity compared to 0% in the AGP. In 2016, HRS included sexual orientation, with 92.7% of respondents identifying as heterosexual, 2.6% gay or lesbian, 1.0% bisexual and 1.3% other. No data were collected by the AGP pertaining to sexual orientation and neither database ask about gender identity. Aging populations are not represented in the anatomy labs at UMMS and likely nationally. Efforts are needed to improve this and enhance the education of the medical professionals, while expanding the end-of-life options for all community members.

Facade Design Process to Establish and Achieve Net Zero Carbon Building Targets

As more stringent building energy codes and sustainability certification goals have become more prevalent in recent years, a focus for many building designers has been reducing the operational energy with the objective of reaching net-zero energy targets. More recently, as the efficiency in operational energy use has increased significantly, the focus is moving towards the environmental impact of building materials, primarily reflected in the embodied energy and emissions, and the potential (re)life options that allow circular material flows and reduced global warming potential. This paper investigates a methodology applied during early and advanced design development phases to assess and compare different façade typology carbon emissions. Embodied carbon is evaluated through Life Cycle Assessment (LCA) analysis, and operational carbon is analysed during the service life of the office building through energy simulation. Results show that overall carbon assessment of different facade solution can provide useful design feedback in the decision-making process.

Liquid and Solid Functional Bio-Based Coatings

The development of new bio-based coating materials to be applied on cellulosic and plastic based substrates, with improved performances compared to currently available products and at the same time with improved sustainable end of life options, is a challenge of our times. Enabling cellulose or bioplastics with proper functional coatings, based on biopolymer and functional materials deriving from agro-food waste streams, will improve their performance, allowing them to effectively replace fossil products in the personal care, tableware and food packaging sectors. To achieve these challenging objectives some molecules can be used in wet or solid coating formulations, e.g., cutin as a hydrophobic water- and grease-repellent coating, polysaccharides such as chitosan-chitin as an antimicrobial coating, and proteins as a gas barrier. This review collects the available knowledge on functional coatings with a focus on the raw materials used and methods of dispersion/application. It considers, in addition, the correlation with the desired final properties of the applied coatings, thus discussing their potential.

A Simple Water Retention Model Based on Grain Size Distribution

The Hunter valley region in NSW Australia is an area with a heavy coal mining presence. As some mines come to their end of life, options are being investigated to improve the topsoil on post mining land for greater plant growth, which may allow economically beneficial farmland to be created. This research is part of an investigation into mixing a mine waste material, coal tailings, with topsoil in order to produce an improved soil for plant growth. Implementing such a solution requires estimation of the drying path of the water retention curves for the tailings and topsoil used. Instead of a lengthy laboratory measurement, a prediction of the drying curve is convenient in this context. No existing prediction models were found that were suitable for these mine materials, hence this paper proposes a simple and efficient model that can more accurately predict drying curves for these mine materials. The drying curves of two topsoils and two tailings from Australian coal mines were measured and compared with predictions using the proposed model, which performs favorably compared to several existing models in the literature. Additionally, the proposed model is assessed using data from a variety of fine- and coarse-grained materials in the literature. It is shown that the proposed model is overall more accurate than every other model assessed, indicating the model may be useful for various materials other than those considered in this study.

Communication About End of Life for Patients Living With Amyotrophic Lateral Sclerosis: A Scoping Review of the Empirical Evidence

Background: Communication about end of life, including advance care planning, life-sustaining therapies, palliative care, and end-of-life options, is critical for the clinical management of amyotrophic lateral sclerosis patients. The empirical evidence base for this communication has not been systematically examined.Objective: To support evidence-based communication guidance by (1) analyzing the scope and nature of research on health communication about end of life for amyotrophic lateral sclerosis; and (2) summarizing resultant recommendations.Methods: A scoping review of empirical literature was conducted following recommended practices. Fifteen health-related and three legal databases were searched; 296 articles were screened for inclusion/exclusion criteria; and quantitative data extraction and analysis was conducted on 211 articles with qualitative analysis on a subset of 110 articles that focused primarily on health communication. Analyses summarized article characteristics, themes, and recommendations.Results: Analysis indicated a multidisciplinary but limited evidence base. Most reviewed articles addressed end-of-life communication as a peripheral focus of investigation. Generic communication skills are important; however, substantive and sufficient disease-related information, including symptom management and assistive devices, is critical to discussions about end of life. Few articles discussed communication about specific end-of-life options. Communication recommendations in analyzed articles draw attention to communication processes, style and content but lack the systematized guidance needed for clinical practice.Conclusions: This review of primary research articles highlights the limited evidence-base and consequent need for systematic, empirical investigation to inform effective communication about end of life for those with amyotrophic lateral sclerosis. This will provide a foundation for actionable, evidence-based communication guidelines about end of life. Implications for research, policy, and practice are discussed.

Introduction

Voluntary stopping eating and drinking (VSED), though relatively unknown and poorly understood, is a widely available option for hastening death. VSED is legally permitted in places where medical assistance in dying (MAID) is not, and unlike U.S. jurisdictions where MAID is legally permitted, VSED is not limited to terminal illness or to those with current decision-making capacity. With adequate clinician and caregiver support, VSED is a compassionate option that respects patient choice. Moreover, the practice is not limited to avoiding unbearable suffering, but may also be used by those who are determined not to live long with unacceptable deterioration such as severe dementia. Despite the misleading image of “starvation,” death by VSED can typically be peaceful and meaningful when accompanied by adequate clinician/caregiver support. VSED is, however, “not for everyone,” and this volume provides a realistic, appropriately critical as well as supportive assessment of the practice. Eight illustrative, previously unpublished real cases are included, receiving pragmatic analysis in each chapter. The volume’s integrated, multi-professional, multidisciplinary character makes it useful for a wide range of readers: patients considering end-of-life options and their families, clinicians of all kinds, ethicists, lawyers, and institutional administrators. Appendices include recommended elements of an advance directive for stopping eating and drinking and what to record as cause of death on the death certificates for those who hasten death by VSED.

Voluntarily Stopping Eating and Drinking

Voluntary stopping eating and drinking (VSED), though relatively unknown and poorly understood, is a widely available option for hastening death. VSED is legally permitted in places where medical assistance in dying (MAID) is not, and unlike U.S. jurisdictions where MAID is legally permitted, VSED is not limited to terminal illness or to those with current decision-making capacity. With adequate clinician and caregiver support, VSED is a compassionate option that respects patient choice. Moreover, the practice is not limited to avoiding unbearable suffering, but may also be used by those who are determined not to live long with unacceptable deterioration such as severe dementia. Despite the misleading image of “starvation,” death by VSED can typically be peaceful and meaningful when accompanied by adequate clinician/caregiver support. VSED is, however, “not for everyone,” and this volume provides a realistic, appropriately critical as well as supportive assessment of the practice. Eight illustrative, previously unpublished real cases are included, receiving pragmatic analysis in each chapter. The volume’s integrated, multi-professional, multidisciplinary character makes it useful for a wide range of readers: patients considering end-of-life options and their families, clinicians of all kinds, ethicists, lawyers, and institutional administrators. Appendices include recommended elements of an advance directive for stopping eating and drinking and what to record as cause of death on the death certificates for those who hasten death by VSED.

The Demands of Liberal Non-Domination

This chapter develops the specific demands of liberal non-domination. It argues that they cover protection against dominatory groups as well as against power relations which are not mediated by authority, or otherwise public; demonstrates how different choices, such as those falling under the basic liberties, connected to intimate personal relationships, or at stake in resource-intensive programs and policies to enhance life options, call for different thresholds of intensity of protection; and how protection must itself be appropriately respectful of people’s moral agency. It goes on to show how the resulting requirements give a wide policy mandate to combat domination not only through formal institutions, but also by fostering a societal ethos and informal social norms, and argues that liberals should not be worried by this wide mandate. It concludes by analysing in which ways demands of protection against domination can, and cannot, be understood as distributive demands.