Effectiveness of Advance Care Planning: What Works, What Doesn't, and What Needs to Change?

An increasing recognition over the past five decades of the importance of patients' autonomy and the right to be able to choose to limit medical treatment at the end of life has led to the development of a number of documents related to advance care planning, including the advance directive, medical power of attorney, and portable orders for life-sustaining treatment (POLST). While these documents are important aspects of advance care planning, without having goals-of-care conversations, a specific plan, and necessary supports to achieve these goals, the documents alone offer a false promise. Healthcare professionals must be trained on how to have indepth goals-of-care conversations with patients and their families, and effectively document the decisions.

Acute cannabis toxicity.

We describe the clinical effects of, and products associated with, acute exposures to cannabis during the early legalization period of recreational cannabis in Oregon and Alaska. This was an observational study of Oregon/Alaska Poison Center data between 4 December 2015 and 15 April 2017. A standardized data collection instrument was created for this study that captured information about cannabis product description, route of exposure, intentional vs unintentional exposure, product dose, product manufacture source, product ownership source, initial vital signs, clinical signs and symptoms, and subject disposition.

Combined Electron-Diffraction, Spectroscopic, and Theoretical Determination of the Structure of N-Deuterio- trans-Methyldiazene, CHN═ND. Conformational Effects of the N═N Double Bond.

Gas phase electron-diffraction (GED) data obtained at a nozzle-tip temperature of 273 K have been combined with spectroscopic vibrational-rotational constants to determine the structure of trans-methyldiazene, an important prototype for the N═N double bond. The N-deuterio form CHN═ND was used in the study since it is appreciably more stable than CHN═NH. Both the theoretical and experimental results are consistent with a planar C trans-CNND framework.