Factors Associated With Inpatient Hospice Utilization Among Hospitalized Decedents With Comfort Measures Only Status.

Patients with serious illness may elect to transition their care to comfort measures only (CMO) while in the hospital. Although studies have shown that routine hospice care is underutilized, the rate of general inpatient hospice (GIP) use among CMO patients during their terminal admission remains unclear. We sought to (1) examine the rate of GIP utilization and (2) identify factors associated with its use among hospitalized CMO decedents.

Simulation training in palliative care: state of the art and future directions.

Background: The growing need for palliative care (PC) among patients with serious illness is outstripped by the short supply of PC specialists. This mismatch calls for competency of all health care providers in primary PC, including patient-centered communication, management of pain and other symptoms, and interprofessional teamwork. Simulation-based medical education (SBME) has emerged as a promising modality to teach key skills and close the educational gap.

Tuning the Excimer Emission of Amphiphilic Platinum(II) Complexes Mediated by Phospholipid Vesicles.

Two new amphiphilic platinum(II) complexes, [Pt(2-(4-fluorophenyl)-5-(4-dodecyloxyphenyl)pyridine) (acac)] (Pt-1) and [Pt(2-(4-dodecyloxyphenyl)-5-(thien-2-yl)-c-cyclopentenepyridine) (acac)] (Pt-2), where acac is acetylacetonate, were synthesized and characterized. Apart from conventional phosphorescence of single molecules (ME-monomer emission), complexes Pt-1 and Pt-2 also exhibit excimer emission (EE) when embedded into phospholipid vesicles, that is assigned to emissive Pt-Pt excimers. The EE intensity in vesicular media appeared to depend on the viscosity of the vesicles and the concentration of the embedded complex.

Modulation of Intersystem Crossing Rate by Minor Ligand Modifications in Cyclometalated Platinum(II) Complexes.

Photophysical properties of four new platinum(II) complexes comprising extended ppy (Hppy = 2-phenylpyridine) and thpy (Hthpy = 2-(2'-thienyl)pyridine) cyclometalated ligands and acetylacetonate (acac) are reported. Substitution of the benzene ring of Pt-ppy complexes 1 and 2 with a more electron-rich thiophene of Pt-thpy complexes 3 and 4 leads to narrowing of the HOMO-LUMO gap and thus to a red shift of the lowest energy absorption band and phosphorescence band, as expected for low-energy excited states of the intraligand/metal-to-ligand charge transfer character. However, in addition to these conventional spectral shifts, another, at first unexpected, substitution effect occurs.

Brightly luminescent Pt(II) pincer complexes with a sterically demanding carboranyl-phenylpyridine ligand: a new material class for diverse optoelectronic applications.

A series of three Pt(II) complexes with a doubly cyclometalating terdentate ligand L1, L1H2 = 3,6-bis(p-anizolyl)-2-carboranyl-pyridine, and diethyl sulfide (1), triphenylphosphine (2), and t-butylisonitrile (3) as ancillary ligands were synthesized. X-ray diffraction studies of 1 and 2 show a coordination of the L1 ligand in a C-N-C mode in which the bulky and rigid o-carborane fragment is cyclometalated via a C atom. Importantly, no close intermolecular Pt-Pt contacts occur with this ligand type.

Activation of εPKC reduces reperfusion arrhythmias and improves recovery from ischemia: optical mapping of activation patterns in the isolated guinea-pig heart.

Unlabelled: Pervious biochemical and hemodynamic studies have highlighted the important role of εPKC in cardioprotection during ischemic preconditioning. However, little is known about the electrophysiological consequences of εPKC modulation in ischemic hearts. Membrane permeable peptide εPKC selective activator and inhibitor were used to investigate the role of εPKC modulation in reperfusion arrhythmias.

Ranolazine stabilizes cardiac ryanodine receptors: a novel mechanism for the suppression of early afterdepolarization and torsades de pointes in long QT type 2.

Background: Ranolazine (Ran) is known to inhibit multiple targets, including the late Na(+)current, the rapid delayed rectifying K(+)current, the L-type Ca(2+)current, and fatty acid metabolism. Functionally, Ran suppresses early afterdepolarization (EADs) and torsades de pointes (TdP) in drug-induced long QT type 2 (LQT2) presumably by decreasing intracellular [Na(+)](i) and Ca(2+)overload. However, simulations of EADs in LQT2 failed to predict their suppression by Ran.

2,2'-Bipyridinyl carboranes as B,N,N-ligands in cyclometallated complexes of platinum(II).

Novel B,N,N-cyclometallated Pt(II) complexes of 2,2'-bipyridin-6-yl carboranes exhibit absorption and emission similar to relative Pt(II) complexes of aromatic C,N,N-ligands: the same transitions but lower intensities. DFT calculations suggest the former emits from the (3)MLCT state while for the latter the mixed (3)ICT-MLCT transitions should be considered.

Phosphorescence vs fluorescence in cyclometalated platinum(II) and iridium(III) complexes of (oligo)thienylpyridines.

Two newly prepared oligothienylpyridines, 5-(2-pyridyl)-5'-dodecyl-2,2'-bithiophene, HL(2), and 5-(2-pyridyl)-5''-dodecyl-2,2':5',2''-ter-thiophene, HL(3), bind to platinum(II) and iridium(III) as N∧C-coordinating ligands, cyclometallating at position C(4) in the thiophene ring adjacent to the pyridine, leaving a chain of either one or two pendent thiophenes. The synthesis of complexes of the form [PtL(n)(acac)] and [Ir(L(n))(2)(acac)] (n = 2 or 3) is described. The absorption and luminescence properties of these four new complexes are compared with the behavior of the known complexes [PtL(1)(acac)] and [Ir(L(1))(2)(acac)] {HL(1) = 2-(2-thienyl)pyridine}, and the profound differences in behavior are interpreted with the aid of time-dependent density functional theory (TD-DFT) calculations.

Synthesis of cyclometallated platinum complexes with substituted thienylpyridines and detailed characterization of their luminescence properties.

Synthesis of various derivatives of 2-(2-thienyl)pyridine via substituted 3-thienyl-1,2,4-triazines is reported. The final step of the synthesis is a transformation of the triazine ring to pyridine in an aza-Diels-Alder-type reaction. The resulting 5-aryl-2-(2-thienyl)pyridines (HL1-HL4) and 5-aryl-2-(2-thienyl)cyclopenteno[c]pyridines (HL5-HL8) (with aryl = phenyl, 4-methoxyphenyl, 2-naphtyl, and 2-thienyl) were used as cyclometallating ligands to prepare a series of eight luminescent platinum complexes of the type [Pt(L)(acac)] (L = cyclometallating ligand, acac = acetylacetonato).

Spatial dispersion of repolarization is a key factor in the arrhythmogenicity of long QT syndrome.

Introduction: The occurrence of significant spatial dispersion of repolarization in vivo as it relates to the mechanism of arrhythmia formation in the long QT syndrome (LQTS) continues to be questioned.

Methods And Results: We investigated a guinea pig model of LQT3 using anthopleurin-A (AP-A) to study the contribution of rate-dependent spatial dispersion of repolarization in the intact heart to the arrhythmogenicity of LQTS. Optical action potentials were measured using potentiometric fluorescent dye di-4ANEPPS in Langendorff-perfused hearts with induced AV block.

Mechanism of discordant T wave alternans in the in vivo heart.

Introduction: Compared to concordant T wave alternans (CA), discordant T wave alternans (DA) may be associated with an increased dispersion of repolarization (DR) and a greater propensity to develop reentrant ventricular tachyarrhythmias. The electrophysiologic mechanisms of DA in the in vivo heart are not well understood.

Methods And Results: The mechanisms of DA were investigated in the canine anthopleurin-A surrogate model of long QT3 syndrome using tridimensional analysis of activation and repolarization patterns from 256 to 384 unipolar electrograms.

A versatile strategy for the synthesis of functionalized 2,2'-bi- and 2,2':6',2' '-terpyridines via their 1,2,4-triazine analogues.

A general synthetic route for the synthesis of functionalized bi- and terpyridines is reported. Functionalized 1,2,4-triazene 4-oxides 7 and 8-obtained from the reaction of hydrazones 1 with pyridine aldehydes and followed by oxidation-are functionalized by introduction of a cyano group via nucleophilic aromatic substitution. The thus-obtained 5-cyano-1,2,4-triazines 9 and 10 undergo facile inverse-electron-demand Diels-Alder reactions with enamines and alkenes to yield functionalized bi- and terpyridines, respectively.

Electrophysiological mechanism of enhanced susceptibility of hypertrophied heart to acquired torsade de pointes arrhythmias: tridimensional mapping of activation and recovery patterns.

Background: Cardiac hypertrophy is associated with increased incidence of sudden death and susceptibility to proarrhythmic effects of antiarrhythmic agents. However, the in vivo electrophysiologic mechanism of the arrhythmias has not been investigated in detail.

Methods And Results: Dose-dependent susceptibility to Torsade de Pointes (TdP) by class III drug dofetilide, 3, 10, and 30 microg/kg, was compared in 6 control dogs (C) and in 5 dogs 6 to 8 weeks after induction of complete atrioventricular block (AVB) that resulted in ventricular hypertrophy (H).