The coronavirus disease 2019 surge in New York City created an increased demand for palliative care (PC) services. In staff-limited settings such as safety net systems, and amid growing reports of health care worker illness, leveraging help from less-affected areas around the country may provide an untapped source of support. A national social media outreach effort recruited 413 telepalliative medicine volunteers (TPMVs). After expedited credentialing and onboarding of 67 TPMVs, a two-week pilot was initiated in partnership with five public health hospitals without any previous existing telehealth structure. The volunteers completed 109 PC consults in the pilot period. Survey feedback from TPMVs and on-site PC providers was largely positive, with areas of improvement identified around electronic health record navigation and continuity of care. This was a successful, proof of concept, and quality improvement initiative leveraging TPMVs from across the nation for a PC pandemic response in a safety net system.

Hypertension in male and aging female rodents is associated with glutamate-dependent plasticity in the hypothalamus, but existing models have failed to capture distinct transitional menopausal phases that could have a significant impact on the synaptic plasticity and emergent hypertension. In rodents, accelerated ovarian failure (AOF) induced by systemic injection of 4-vinylcyclohexane diepoxide mimics the estrogen fluctuations seen in human menopause including the perimenopause transition (peri-AOF) and postmenopause (post-AOF). Thus, we used the mouse AOF model to determine the impact of slow-pressor angiotensin II (AngII) administration on blood pressure and on the subcellular distribution of obligatory N-methyl-D-aspartate (NMDA) receptor GluN1 subunits in the paraventricular hypothalamic nucleus (PVN), a key estrogen-responsive cardiovascular regulatory area. Estrogen-sensitive neuronal profiles were identified in mice expressing enhanced green fluorescent protein under the promoter for estrogen receptor (ER) β, a major ER in the PVN. Slow-pressor AngII increased arterial blood pressure in mice at peri- and post-AOF time points. In control oil-injected (nonhypertensive) mice, AngII decreased the total number of GluN1 in ERβ-containing PVN dendrites. In contrast, AngII resulted in a reapportionment of GluN1 from the cytoplasm to the plasma membrane of ERβ-containing PVN dendrites in peri-AOF mice. Moreover, in post-AOF mice, AngII increased total GluN1, dendritic size and radical production in ERβ-containing neurons. These results indicate that unique patterns of hypothalamic glutamate receptor plasticity and dendritic structure accompany the elevated blood pressure in peri- and post-AOF time points. Our findings suggest the possibility that distinct neurobiological processes are associated with the increased blood pressure during perimenopausal and postmenopausal periods.

Co-creation is health professionals' and systems' development of health care together with patients and families. Such collaborations yield an exchange of values, ideas, and priorities that can individualize care for each patient. Co-creation has been discussed interchangeably with coproduction and shared decision making; this article explores co-creation through the lens of quality improvement. Although there are barriers to co-creation including physician autonomy, patient overwhelm, and conflicts of interest, co-creation has been shown to promote patient engagement, peer learning, and improved outcomes. Further research is needed in co-creation for systems improvement. The History of Co-CreationA recent development in health care, co-creation has roots in the fields of management and public policy [1]. At its core, co-creation refers to a process of gathering input from various stakeholders with the common goal of producing a service or product [2]. Since multiple parties contribute to a collective effort in co-creation, the resulting service or product is theoretically of value for all involved [3]. In such a system, creation shifts from being a top-down to a negotiated process [4].The notion of co-creation was first formulated by Elinor Ostrom more than three decades ago [5]. In her case studies of public officials in Kenya and Brazil, Ostrom described the high level of public input that was gathered before decisions were made about infrastructure and education [6]. The first step in the design of new sanitation systems, for example, was setting up neighborhood meetings. This allowed citizens to express their specific needs and be informed about the effects of construction in their neighborhood [6]. Since this groundbreaking work was published, the applications of cocreation have progressed substantially. Now interchangeable with co-production, cocreation provides an incentive to mobilize resources, broadly construed, for service planning [4]. In other words, the combination of different points of view is considered a resource in and of itself, especially when the partnership utilizes marginalized viewpoints as previously unexplored community resources [7].

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