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Purpose of Review Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This review elucidates the current practice and ongoing evolution of PC psychiatry. Recent Findings PC psychiatry leverages training and clinical practices from both PC and psychiatry, addressing a wide range of needs, including enhanced psychiatric care for patients with serious medical illness, PC access for patients with medical needs in psychiatric settings, and PC-informed psychiatric approaches for individuals with treatment-refractory serious mental illness. PC psychiatry is practiced by a diverse workforce comprising hospice and palliative medicine–trained psychiatrists, psycho-oncologists, geriatric psychiatrists, other mental health professionals, and non-psychiatrist PC clinicians. As a result, PC psychiatry faces challenges in defining its operational scope. The manuscript outlines the growth, current state, and prospects of PC psychiatry. It examines its roles across various healthcare settings, including medical, integrated care, and psychiatric environments, highlighting the unique challenges and opportunities in each. Summary PC psychiatry is a vibrant and growing subspecialty of psychiatry that must be operationalized to continue its developmental trajectory. There is a need for a distinct professional identity for PC psychiatry, strategies to navigate administrative and regulatory hurdles, and greater support for novel clinical, educational, and research initiatives.

Opinion statement Patients with hematologic malignancies and their families are among the most distressed of all those with cancer. Despite high palliative care-related needs, the integration of palliative care in hematology is underdeveloped. The evidence is clear that the way forward includes standard-of-care PC integration into routine hematologic malignancy care to improve patient and caregiver outcomes. As the PC needs for patients with blood cancer vary significantly by disease, a disease-specific PC integration strategy is needed, allowing for serious illness care interventions to be individualized to the specific needs of each patient and situation.

The American healthcare system faces a crisis in optimizing care for people with serious, life-threatening illnesses. Many Americans lack basic knowledge of how palliative care services could be helpful, and unfortunately many healthcare providers lack sufficient training to meet the expanding palliative-care needs of our aging population. This article presents a framework for the development of population-based palliative-care education.

Context and objective Opioids have heterogeneous side effects including a well-known effect of sedation; however, the opposing effect of stimulation, or somatic activation, has been largely ignored or overlooked. The objective of this study is to determine the prevalence of opioid-induced somatic activation (OISA). Methods We conducted a retrospective chart review of 189 patients seen by a single clinical psychiatrist/pain specialist. During the initial encounter, the clinician took a standardized history of every opioid currently or previously taken by the patients, and enquired if the patients had experienced a somatically activating or sedating effect per opioid. Results Patients recalled an average exposure to 5.1 opioids (SD: 1.9). Ninety-one patients (48.1%; mean: 1.6) reported somatic activation, while 118 (62.4%; mean: 1.7) reported sedation from at least one opioid. Fifty-eight patients (30.7%) identified at least one opioid as activating, and another as sedating. The distribution of OISA did not significantly differ by gender, race, primary pain diagnosis, or depression. The distribution of OISA by oxycodone significantly differed compared to morphine sulfate (27.3% vs 8.9%; p: 0.005), while sedation did not (29.0% vs 24.3%; p: 0.46). Conclusions In this study, we quantified the previously unstudied phenomenon of OISA. This phenomenon appears dependent on opioid type with some opioids, such as oxycodone, appearing more likely to have this effect. Given current concerns about the risks of opioids in high-risk populations, future studies are needed to study this phenomenon to arrive at an accurate determination of the potential risks and benefits of OISA.

2 Methods We conducted a cross-sectional analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS; www.cdc.gov/nchs/ahcd/)—a nationally representative dataset collected by the Center for Disease Control and Prevention of ambulatory care services provided within general and short-stay EDs. Author contributions M.H. provided substantial contributions to the conception and design, acquisition of data, or analysis and interpretation of data; J.W. drafted the article or revised it critically for important intellectual content; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Declaration of competing interest Micah Hartwell receives funding from the National Institute of Justice and Human Resources Services Agency, which is unrelated to this research.

John Webb was a masterly technical surgeon and pioneer cytologist. In an era when a lump in the breast presaged uncertain frozen section biopsy and mastectomy, Webb mastered fine needle aspiration and accurate diagnosis, saving countless patients from avoidable surgery. His work forms the basis of the routine investigation of suspected breast cancer in modern practice.

Background. Beta-lactam antibiotics are a commonly used treatment for severe sepsis, with intermittent bolus dosing standard therapy, despite a strong theoretical rationale for continuous administration. The aim of this trial was to determine the clinical and pharmacokinetic differences between continuous and intermittent dosing in patients with severe sepsis. Methods. This was a prospective, double-blind, randomized controlled trial of continuous infusion versus intermittent bolus dosing of piperacillin-tazobactam, meropenem, and ticarcillin-clavulanate conducted in 5 intensive care units across Australia and Hong Kong. The primary pharmacokinetic outcome on treatment analysis was plasma antibiotic concentration above the minimum inhibitory concentration (MIC) on days 3 and 4. The assessed clinical outcomes were clinical response 7–14 days after study drug cessation, ICU-free days at day 28 and hospital survival. Results. Sixty patients were enrolled with 30 patients each allocated to the intervention and control groups. Plasma antibiotic concentrations exceeded the MIC in 82% of patients (18 of 22) in the continuous arm versus 29% (6 of 21) in the intermittent arm (P = .001). Clinical cure was higher in the continuous group (70% vs 43%; P = .037), but ICU-free days (19.5 vs 17 days; P = .14) did not significantly differ between groups. Survival to hospital discharge was 90% in the continuous group versus 80% in the intermittent group (P = .47). Conclusions. Continuous administration of beta-lactam antibiotics achieved higher plasma antibiotic concentrations than intermittent administration with improvement in clinical cure. This study provides a strong rationale for further multicenter trials with sufficient power to identify differences in patient-centered endpoints.

Machine learning systems are infiltrating our lives and are beginning to become important in our education systems. This article, developed from a synthesis and analysis of previous research, examines the implications of recent developments in machine learning for human learners and learning. In this article we first compare deep learning in computers and humans to examine their similarities and differences. Deep learning is identified as a sub-set of machine learning, which is itself a component of artificial intelligence. Deep learning often depends on backwards propagation in weighted neural networks, so is non-deterministic—the system adapts and changes through practical experience or training. This adaptive behaviour predicates the need for explainability and accountability in such systems. Accountability is the reverse of explainability. Explainability flows through the system from inputs to output (decision) whereas accountability flows backwards, from a decision to the person taking responsibility for it. Both explainability and accountability should be incorporated in machine learning system design from the outset to meet social, ethical and legislative requirements. For students to be able to understand the nature of the systems that may be supporting their own learning as well as to act as responsible citizens in contemplating the ethical issues that machine learning raises, they need to understand key aspects of machine learning systems and have opportunities to adapt and create such systems. Therefore, some changes are needed to school curricula. The article concludes with recommendations about machine learning for teachers, students, policymakers, developers and researchers.

aim: The decision for a patient to undergo a laryngectomy is an extremely important one. The aim of our research was to review the readability of international laryngectomy patient information and compare this with Australian and New Zealand resources. methods: Online searches were undertaken using the terms “laryngectomy”, “laryngectomy patient information”, “voice box removal” and “voice box removal patient information”. Twenty-nine articles were included for review. The primary outcomes measures were the Flesch–Kincaid Grade Level, the Flesch Reading Ease Score, the Gunning Fog Index, the Coleman–Liau Index, the SMOG Index, the Automated Readability Index and the Linsear Write Formula. results: Overall, we found that laryngectomy patient information from Australian and New Zealand sources was more difficult for patients to understand compared with international sources. The average Flesch–Kincaid Grade Level (equivalent to the United States grade level of education) for Australian and New Zealand websites was 10.41, compared with 9.09 for international websites. For reference, guidelines suggest that articles aimed at the public should have a grade level of 8. Similarly, the average Flesch Reading Ease Score was 55.8 and 58.23 for Australian/New Zealand and international resources respectively—which correlate to “fairly hard” to read, rather than the “easy” or “very easy” categories that are recommended for the general population. conclusion: For the resources analysed, Australian and New Zealand laryngectomy patient information was less readable than information distributed by international organisations, and is at a high risk of being too complicated for patients to read and understand. Consideration should be given to distributing patient information accessible to patients with lower literacy levels.

Despite the success of antiretroviral therapy (ART) to halt viral replication and slow disease progression, this treatment is not curative and there remains an urgent need to develop approaches to clear the latent HIV reservoir. The human IL-15 superagonist N-803 (formerly ALT-803) is a promising anti-cancer biologic with potent immunostimulatory properties that has been extended into the field of HIV as a potential \"shock and kill\" therapeutic for HIV cure. However, the ability of N-803 to reactivate latent virus and modulate anti-viral immunity in vivo under the cover of ART remains undefined. Here, we show that in ART-suppressed, simian-human immunodeficiency virus (SHIV)SF162P3-infected rhesus macaques, subcutaneous administration of N-803 activates and mobilizes both NK cells and SHIV-specific CD8+ T cells from the peripheral blood to lymph node B cell follicles, a sanctuary site for latent virus that normally excludes such effector cells. We observed minimal activation of memory CD4+ T cells and no increase in viral RNA content in lymph node resident CD4+ T cells post N-803 administration. Accordingly, we found no difference in the number or magnitude of plasma viremia timepoints between treated and untreated animals during the N-803 administration period, and no difference in the size of the viral DNA cell-associated reservoir post N-803 treatment. These results substantiate N-803 as a potent immunotherapeutic candidate capable of activating and directing effector CD8+ T and NK cells to the B cell follicle during full ART suppression, and suggest N-803 must be paired with a bona fide latency reversing agent in vivo to facilitate immune-mediated modulation of the latent viral reservoir.