IMPORTANCE Seriously ill hospitalized patients have identified communication and decision making about goals of care as high priorities for quality improvement in end-of-life care. Interventions to improve care are more likely to succeed if tailored to existing barriers.OBJECTIVE To determine, from the perspective of hospital-based clinicians, (1) barriers impeding communication and decision making about goals of care with seriously ill hospitalized patients and their families and (2) their own willingness and the acceptability for other clinicians to engage in this process. DESIGN, SETTING, AND PARTICIPANTSMulticenter survey of medical teaching units of nurses, internal medicine residents, and staff physicians from participating units at 13 university-based hospitals from 5 Canadian provinces. MAIN OUTCOMES AND MEASURESImportance of 21 barriers to goals of care discussions rated on a 7-point scale (1 = extremely unimportant; 7 = extremely important). RESULTS Between September 2012 and March 2013, questionnaires were returned by 1256 of 1617 eligible clinicians, for an overall response rate of 77.7% (512 of 646 nurses [79.3%], 484 of 634 residents [76.3%], 260 of 337 staff physicians [77.2%]). The following family member-related and patient-related factors were consistently identified by all 3 clinician groups as the most important barriers to goals of care discussions: family members' or patients' difficulty accepting a poor prognosis (mean [SD] score, 5.8 [1.2] and 5.6 [1.3], respectively), family members' or patients' difficulty understanding the limitations and complications of life-sustaining treatments (5.8 [1.2] for both groups), disagreement among family members about goals of care (5.8 [1.2]), and patients' incapacity to make goals of care decisions (5.6 [1.2]). Clinicians perceived their own skills and system factors as less important barriers. Participants viewed it as acceptable for all clinician groups to engage in goals of care discussions-including a role for advance practice nurses, nurses, and social workers to initiate goals of care discussions and be a decision coach.CONCLUSIONS AND RELEVANCE Hospital-based clinicians perceive family member-related and patient-related factors as the most important barriers to goals of care discussions. All health care professionals were viewed as playing important roles in addressing goals of care. These findings can inform the design of future interventions to improve communication and decision making about goals of care.

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A cholesteric liquid crystal can be considered as a one-dimensional photonic crystal with a refractive index that is regularly modulated along the helix axis because of the particular arrangement of the molecules. The result is that the propagation of light is suppressed for a particular range of wavelengths (bandgap). A polymer-stabilized cholesteric liquid crystal (PSCLC), which is obtained by in situ photopolymerization of reactive liquid-crystal molecules in the presence of non-reactive liquid-crystal molecules in an oriented Bragg planar texture, is elaborated by combining the UV-curing with a thermally induced pitch variation. As a consequence, it is shown here that memory effects are introduced into the characteristics of the reflection band of the material at room temperature. In the visible spectrum, the reflection bandwidth can be tuned in agreement with the thermal ramp and broadened. In addition, the bandgap filters can be switched between broadband reflective, scattering and transparent states by subjecting them to an electric field. Related application fields of these functional materials are switchable smart windows for the control of the solar-light spectrum and white-or-black polarizer-free reflective displays.

Using drone aircraft to deliver healthcare and other health-related services is a relatively new application of this technology in North America. For health service providers, drones represent a feasible means to increase their efficiency and ability to provide services to individuals, especially those in difficult to reach locations. This paper presents the results of a scoping review of the research literature to determine how drones are used for healthcare and health-related services in North America, and how such applications account for human operating and machine design factors. Data were collected from PubMed, CINAHL, Scopus, Web of Science, and IEEE Xplore using a block search protocol that combined 13 synonyms for “drone” and eight broad terms capturing healthcare and health-related services. Four-thousand-six-hundred-and-sixty-five documents were retrieved, and following a title, abstract, and full-text screening procedure completed by all authors, 29 documents were retained for analysis through an inductive coding process. Overall, findings indicate that drones may represent a financially feasible means to promote healthcare and health-related service accessibility for those in difficult-to-reach areas; however, further work is required to fully understand the costs to healthcare organizations and the communities they serve.