Assessing Photostability of mAb Formulations In Situ Using Light-Coupled NMR Spectroscopy.

Biopharmaceuticals, such as monoclonal antibodies (mAbs), need to maintain their chemical and physical stability in formulations throughout their lifecycle. It is known that exposure of mAbs to light, particularly UV, triggers chemical and physical degradation, which can be exacerbated by trace amounts of photosensitizers in the formulation. Although routine assessments of degradation following defined UV dosages are performed, there is a fundamental lack of understanding regarding the intermediates, transient reactive species, and radicals formed during illumination, as well as their lifetimes and immediate impact post-illumination. In this study, we used light-coupled NMR spectroscopy to monitor in situ live spectral changes in sealed samples during and after UV-A illumination of different formulations of four mAbs without added photosensitizers. We observed a complex evolution of spectra, reflecting the appearance within minutes of transient radicals during illumination and persisting for minutes to tens of minutes after the light was switched off. Both mAb and excipient signals were strongly affected by illumination, with some exhibiting fast irreversible photodegradation and others exhibiting partial recovery in the dark. These effects varied depending on the mAb and the presence of excipients, such as polysorbate 80 (PS80) and methionine. Complementary ex situ high-performance size-exclusion chromatography analysis of the same formulations post-UV exposure in the chamber revealed significant loss of purity, confirming formulation-dependent degradation. Both approaches suggested the presence of degradation processes initiated by light but continuing in the dark. Further studies on photoreaction intermediates and transient reactive species may help mitigate the impact of light on biopharmaceutical degradation.

The perspective of school leaders on the implementation of evidence-based practices: A mixed methods study.

Background: School leaders play an integral role in the use of implementation strategies, which in turn support special education teachers in the implementation of evidence-based practices (EBPs). In this convergent mixed methods study, we explored school leaders' perceptions of the facilitators and barriers to EBP implementation, particularly for students receiving special education, as well as the importance and feasibility of 15 implementation strategies. Method: School leaders (N = 22, principals, assistant principals, school psychologists, etc.) participated in a semistructured interview that included three parts-qualitative questions, quantitative ratings of strategies' importance and feasibility, and discussion of the top three implementation strategies. Data strands were analyzed independently and then integrated to generate meta-inferences. Results: The qualitative data identified facilitators such as access to resources about the intervention (e.g., professional development) and collaboration and teamwork, while barriers centered on lack of school supports, culture/climate, and organizational factors (e.g., lack of communication). The quantitative data indicated that the implementation strategy provide ongoing consultation/coaching was rated as important and feasible. Monitor the progress of the implementation effort was rated as important but less feasible, while conduct educational meetings and change the environment were rated as feasible, but less important. Build partnerships to support implementation was rated as less important and feasible. There was convergence and divergence in mixed methods findings. Conclusion: This study underscores the critical need to increase school leaders' knowledge and skills related to implementation science to better leverage implementation strategies that address the confluence of relevant implementation determinants.

School leaders, such as principals, assistant principals, and school psychologists, are responsible for supporting special education teachers in doing interventions (e.g., through teacher training). In this study, we interviewed 22 school leaders to understand what factors support or hinder teachers in doing interventions, especially for students receiving special education. We also provided school leaders with a list of 15 strategies that may be used to support teachers, to determine which strategies school leaders think are the most important and feasible in schools. Our results indicated that it is important to train school leaders on how to move research into practice settings, such as schools. It is equally important for researchers and policymakers to understand the priorities of school leaders.

Core Components and Implementation Determinants of Multilevel Service Delivery Frameworks Across Child Mental Health Service Settings.

Multilevel service delivery frameworks are approaches to structuring and organizing a spectrum of evidence-based services and supports, focused on assessment, prevention, and intervention designed for the local context. Exemplar frameworks in child mental health include positive behavioral interventions and supports in education, collaborative care in primary care, and systems of care in community mental health settings. Yet, their high-quality implementation has lagged. This work proposes a conceptual foundation for multilevel service delivery frameworks spanning diverse mental health service settings that can inform development of strategic implementation supports. We draw upon the existing literature for three exemplar multilevel service delivery frameworks in different child mental health service settings to (1) identify core components common to each framework, and (2) to highlight prominent implementation determinants that interface with each core component. Six interrelated components of multilevel service delivery frameworks were identified, including, (1) a systems-level approach, (2) data-driven problem solving and decision-making, (3) multiple levels of service intensity using evidence-based practices, (4) cross-linking service sectors, (5) multiple providers working together, including in teams, and (6) built-in implementation strategies that facilitate delivery of the overall model. Implementation determinants that interface with core components were identified at each contextual level. The conceptual foundation provided in this paper has the potential to facilitate cross-sector knowledge sharing, promote generalization across service settings, and provide direction for researchers, system leaders, and implementation intermediaries/practitioners working to strategically support the high-quality implementation of these frameworks.

Comparing Informants for Mental Health Screening at the Preschool Level.

Universal screening for mental health in preschools provides the opportunity for early identification and early intervention, but guidance regarding which informants to use is needed. Preschoolers' (N = 535) parent and teacher reports across two screening forms were analyzed to determine similarities and discrepancies for classification results and screener scores. The analyses also examined if an additional rater provided incrementally valid information to the prediction of longitudinal kindergarten outcomes. Parents' and teachers' screening scores were significantly correlated across forms by rater and across raters. However, categorical classification results indicated that teachers were more likely than parents to rate preschoolers in at-risk ranges across forms. Finally, hierarchical regression analyses revealed teacher ratings were predictive of kindergarten social-emotional, cognitive, and academic outcomes, and that the addition of parent ratings did not significantly improve prediction of outcomes. Implications are discussed in the context of multiple raters within multiple-gating screening procedures.

Interactional quality in middle schools: Latent profiles and their associations with teacher, classroom, and school compositional factors.

High quality teacher-student interactions are critical for the healthy social-emotional, behavioral, and academic development of middle school students. However, few studies have explored patterns of teacher-student interactions in middle school classrooms or the relation between teacher-, classroom-, and school-level factors and patterns of interaction. The current study employed latent profile analyses (LPA) to identify patterns of teacher-student interactional quality in a sample of 334 teachers from 41 schools serving middle school students within the Mid-Atlantic region of the U.S. Three distinct profiles of teacher-student interactional quality were identified that were characteristic of higher, lower, and intermediate quality and were differentially related to teacher, classroom, and school characteristics. Compared to classrooms with lower interactional quality, classrooms with "higher" or "intermediate" profiles were more likely to be taught by early career teachers, to have higher rates of observed student cooperation, and to be in schools in rural fringe areas. Classrooms with lower interactional quality were more likely to have larger student-to-teacher ratios and higher rates of student disruptive behaviors than classrooms with intermediate interactional quality and to be in schools with a higher percentage of out-of-school suspensions than classrooms with higher interactional quality. These findings suggest that interventions at the teacher, classroom, and school levels may promote positive teacher-student interactions, such as consultation to support teachers' effective classroom management, alternatives to out-of-school suspensions, and smaller student-to-teacher ratios.

Moving towards Implementation of Universal Mental Health Screening by Examining Attitudes toward School-based Practices.

Universal mental health screening is a proactive approach to identify students who may benefit from prevention or early intervention services. Despite known benefits, few schools are engaging in screening efforts and it is critical to examine factors that may impede or enhance implementation. Following implementation of a universal screening program across five preschools and elementary schools, this study investigated the attitudes of teachers (N = 40) and parents (N = 330) and found strong agreement among stakeholders about the acceptability and appropriateness of universal mental health screening. Teachers and parents expressed less willingness to regularly complete screening forms, yet teachers reported that the Behavior Assessment System for Children - Third Edition: Behavioral Emotional Screening System was a usable screening tool. Implications and future directions to enhance implementation efforts are discussed.

Structural School Characteristics and Neighborhood Risk Factors: Associations with Student-Reported School Climate in a Large, Urban Public School District in the United States.

School climate consistently predicts youth academic success, social-emotional well-being, and substance use, and positive school climate can buffer the negative effects of community violence exposure on youth development. Various structural school and neighborhood factors have been associated with school climate, but prior research has not examined these relations comprehensively. We examined the relation between 18 school building and school neighborhood factors with student-reported school climate among 15,833 students in 124 public schools in a large, urban district in the United States. In this sample, attendance rate was most consistently associated with school climate (ß = 0.015; p < .001). Teacher years of experience, mobility rate, number of students in special education, adult arrests in the school neighborhood, and service calls for shootings and dirty streets and alleys in the school neighborhood were also significantly associated with various domains of school climate. These findings highlight the need for future longitudinal research on the influence of both school building and school neighborhood factors on school climate for public schools. Schools in our sample had a wide range of school climate scores despite consistently high crime rates and other structural risk factors such as low socioeconomic status throughout the city, so there are implications for researchers and education leaders to work together to identify opportunities for schools to foster positive school climate despite systemic school and/or neighborhood risk factors.

Specifying and Reporting Implementation Strategies Used in a School-Based Prevention Efficacy Trial.

BACKGROUND: Implementation strategies used to enhance the implementation of interventions during efficacy and effectiveness studies are rarely reported. Tracking and reporting implementation strategies during these phases has potential to improve future research studies and real-world implementation. We present an exemplar of how this might be executed by specifying and reporting the implementation strategies that were used during a school-based efficacy trial, Project POWER, which tested a trauma-informed prevention program delivered by a university research team, community members, and school staff facilitators in 29 schools. METHODS: Following the conclusion of the 4-year trial, core Project POWER research team members identified the implementation strategies that supported intervention delivery during the trial using an established taxonomy of school-based implementation strategies. The actors, actions, action targets, temporality, dose, and implementation outcomes were specified using established implementation strategies reporting guidelines. RESULTS: The research team identified 37 implementation strategies that were used during the Project POWER trial. Most strategies fell within the categories of Train and Educate Stakeholders, Use Evaluative and Iterative Strategies, and Develop Stakeholder Interrelationships. Actors included members of the research team and partner schools. Strategies were used multiple times during the preparation and implementation phases. Action targets were most often characteristics of individuals, implementation process, and characteristics of the inner setting. Strategies predominantly targeted the implementation outcomes of fidelity, acceptability, feasibility, and adoption. CONCLUSIONS: This study provided evidence that implementation strategies are used and can be identified in efficacy research using a retrospective approach. Identifying and specifying implementation strategies used during the initial phases of the translational research pipeline can inform the implementation strategies that are carried forward, adapted, or discontinued in future trials and routine practice to improve implementation and effectiveness outcomes.

Social and Contextual Influences on Mental Health Following an Episode of Mass Violence.

Few studies explore how the recovery context following an episode of mass violence affects posttragedy mental health (MH), despite clear implications for developing posttrauma supports. Following a mass murder, this prospective, longitudinal study examined how reactions to media coverage, family reactions, and disappointment in social support influenced posttragedy MH (posttraumatic stress, depression, anxiety), above and beyond the influence of pretragedy MH, pretragedy victimization, and objective exposure. University students who participated in a study of college adjustment prior to the mass murder (n = 593) were recontacted and provided information on their posttragedy life (n = 142). Students (n = 84) also responded to open-ended questions about what was the most stressful part of the tragedy and psychological effects of the mass murder. After accounting for pretragedy victimization and MH, and objective exposure to events, hierarchical regression analyses indicated that distress related to media coverage and stronger family reactions contributed to higher levels of posttraumatic stress symptoms and anxiety, but not depression. Disappointment with social support was not significantly related to posttragedy MH. Common themes in student comments include grief, feeling vulnerable/unsafe, concern for the impact on others, stress related to media coverage, proximity to the events, changes in psychosocial adjustment, and returning to daily life. Results suggest that negative reactions to media coverage and family reactions that are overprotective or distressing negatively affect survivors' MH, beyond their objective exposure to the violence, pretragedy MH, and pretragedy victimization.

Organizational Context in General and Special Education: An Exploratory Investigation to Describe the Perspective of School Leaders.

Organizational context (e.g., climate, culture, resources) can impede or enhance implementation of evidence-based practices in general education settings or special education settings serving students with autism spectrum disorder. We examined the relations between organizational context and individual (i.e., implementation leadership, administrator- or service provider-role) or school (i.e., enrollment size, public/nonpublic school type) characteristics. Participants were administrative or service providing leaders (n = 34) from 11 schools in one state on the East Coast of the United States. School leaders' average ratings of the organizational context were generally more positive for special education than general education; however, greater culture stress was reported for special education. Correlation analyses indicated being an administrator and implementation leadership were positively associated with implementation climate in both education settings. Being an administrator was also positively associated with cultural effort (i.e., how hard people work towards achieving goals) in special education, but negatively associated with culture stress in general education. In special education, nonpublic schools had better climates (both learning and implementation), but more culture stress. Additionally, school enrollment size was negatively related to available resources and implementation climate in special education. Investigating the similarities and differences in organizational context across educational settings is needed in future research.

Metabolic Architecture of Acute Exercise Response in Middle-Aged Adults in the Community.

BACKGROUND: Whereas regular exercise is associated with lower risk of cardiovascular disease and mortality, mechanisms of exercise-mediated health benefits remain less clear. We used metabolite profiling before and after acute exercise to delineate the metabolic architecture of exercise response patterns in humans. METHODS: Cardiopulmonary exercise testing and metabolite profiling was performed on Framingham Heart Study participants (age 53±8 years, 63% women) with blood drawn at rest (n=471) and at peak exercise (n=411). RESULTS: We observed changes in circulating levels for 502 of 588 measured metabolites from rest to peak exercise (exercise duration 11.9±2.1 minutes) at a 5% false discovery rate. Changes included reductions in metabolites implicated in insulin resistance (glutamate, -29%; P=1.5×10-55; dimethylguanidino valeric acid [DMGV], -18%; P=5.8×10-18) and increases in metabolites associated with lipolysis (1-methylnicotinamide, +33%; P=6.1×10-67), nitric oxide bioavailability (arginine/ornithine + citrulline, +29%; P=2.8×10-169), and adipose browning (12,13-dihydroxy-9Z-octadecenoic acid +26%; P=7.4×10-38), among other pathways relevant to cardiometabolic risk. We assayed 177 metabolites in a separate Framingham Heart Study replication sample (n=783, age 54±8 years, 51% women) and observed concordant changes in 164 metabolites (92.6%) at 5% false discovery rate. Exercise-induced metabolite changes were variably related to the amount of exercise performed (peak workload), sex, and body mass index. There was attenuation of favorable excursions in some metabolites in individuals with higher body mass index and greater excursions in select cardioprotective metabolites in women despite less exercise performed. Distinct preexercise metabolite levels were associated with different physiologic dimensions of fitness (eg, ventilatory efficiency, exercise blood pressure, peak Vo2). We identified 4 metabolite signatures of exercise response patterns that were then analyzed in a separate cohort (Framingham Offspring Study; n=2045, age 55±10 years, 51% women), 2 of which were associated with overall mortality over median follow-up of 23.1 years (P≤0.003 for both). CONCLUSIONS: In a large sample of community-dwelling individuals, acute exercise elicits widespread changes in the circulating metabolome. Metabolic changes identify pathways central to cardiometabolic health, cardiovascular disease, and long-term outcome. These findings provide a detailed map of the metabolic response to acute exercise in humans and identify potential mechanisms responsible for the beneficial cardiometabolic effects of exercise for future study.

Clinical and Hemodynamic Associations and Prognostic Implications of Ventilatory Efficiency in Patients With Preserved Left Ventricular Systolic Function.

BACKGROUND: Ventilatory efficiency (minute ventilation required to eliminate carbon dioxide, VE/VCO2) during exercise potently predicts outcomes in advanced heart failure with reduced ejection fraction, but its prognostic significance for at-risk individuals with preserved left ventricular systolic function is unclear. We aimed to characterize mechanistic determinants and prognostic implications of VE/VCO2 in a single-center dyspneic referral cohort (MGH-ExS [Massachusetts General Hospital Exercise Study]) and in a large sample of community-dwelling participants in the FHS (Framingham Heart Study). METHODS: Maximum incremental cardiopulmonary exercise tests were performed. VE/VCO2 was assessed as the slope pre- and post-ventilatory anaerobic threshold (VE/VCO2pre-VATslope, VE/VCO2post-VATslope), the slope throughout exercise (VE/VCO2overall-slope), and as the lowest 30-second value (VE/VCO2nadir). RESULTS: In the MGH-ExS (N=493, age 56±15 years, 61% women, left ventricular ejection fraction 64±8%), higher VE/VCO2nadir was associated with lower peak exercise cardiac output and steeper increases in exercise pulmonary capillary wedge pressure (both P<0.0001). VE/VCO2nadir (hazard ratio, 1.34 per 1-SD unit [95% CI, 1.10-1.62] P=0.003) was associated with future cardiovascular hospitalization/death and outperformed classical VE/VCO2 measures used in heart failure with reduced ejection fraction (VE/VCO2overall-slope). In FHS (N=1936, age 54±9 years, 53% women), VE/VCO2 measures taken in low-to-moderate intensity exercise (including VE/VCO2pre-VATslope, VE/VCO2nadir) were directly associated with cardiovascular risk factor burden (smoking, Framingham cardiovascular disease risk score, and lower fitness; all P<0.001). CONCLUSIONS: Impaired ventilatory efficiency is associated with cardiovascular risk in the community and with adverse hemodynamic profiles and future hospitalizations/death in a referral population, highlighting the prognostic importance of easily acquired submaximum exercise ventilatory gas exchange measurements in broad populations with preserved left ventricular systolic function.

An Empirical Approach to Complete Mental Health Classification in Adolescents.

Using latent profile analysis (LPA), this study empirically identified dual-factor mental health subtypes, with a goal of examining structural stability of emerging latent classes over three high school years. Profiles' relations with distal indicators of well-being, psychosocial distress, and self-reported grades were examined to explore the validity of emerging classes. A sample of 332 high school students reported on their social-emotional strengths and psychological distress during the fall term of their ninth-, tenth-, and eleventh-grade years. In Grade 12, students reported on measures assessing their grades and social-emotional experiences. Independent LPAs for each grade year yielded four mental health subtypes - complete mental health, moderately mentally healthy, symptomatic but content, and troubled - and provided evidence for the structural stability of the dual-factor mental health construct. Across high school years, most students were in the complete or moderately mentally healthy classes, with the troubled class consistently representing the smallest proportion of the sample. Students in classes with higher levels of strengths and lower levels of distress reported higher grades, prosocial contribution to community, and higher life satisfaction, and fewer symptoms of anxiety and depression. Implications and future directions for research and school-based practice are discussed.

Languishing Students: Linking Complete Mental Health Screening in Schools to Tier II Intervention.

Despite innovations in the screening and early identification of students who may benefit from school mental health services, many schools struggle to link screening to intervention decisions, particularly at the Tier II level. Universal complete mental health screening, which measures strengths along with risk factors, is a strength-based approach that enables identification of students who do not report active mental health risk yet have limited psychosocial strengths. These languishing students are ideal candidates for Tier II interventions. Using a case study to link screening to intervention, this paper describes a contemporary approach to complete mental health screening, identify candidates for Tier II intervention, select appropriate interventions, and monitor student outcomes. Implications and challenges for school psychologists are discussed.

A latent transition analysis of the longitudinal stability of dual-factor mental health in adolescence.

Dual-factor models of mental health are increasingly supported but little is known about longitudinal trends in dual-factor mental health. The current study used latent profile analysis (LPA) to empirically identify dual-factor mental health classes at each of Grades 9 through 12 and latent transition analysis (LTA) to examine stability of classes over four academic years. A sample of 875 adolescents from two cohorts reported on their social-emotional strengths and psychological distress. Cross-sectional LPAs for each grade year resulted in four mental health classes: complete mental health, moderately mentally healthy, symptomatic but content, and troubled. An LTA model indicated that the complete mental health class exhibited the most stability, followed by moderately mentally healthy and symptomatic but content classes. The troubled class exhibited the least stability. Less than 24% of participants remained in the same mental health class across all years. Findings support regular monitoring of students' dual-factor mental health to accurately inform mental health promotion, prevention, and intervention efforts.

Patient engagement with a mobile web-based telemonitoring system for heart failure self-management: a pilot study.

BACKGROUND: Intensive remote monitoring programs for congestive heart failure have been successful in reducing costly readmissions, but may not be appropriate for all patients. There is an opportunity to leverage the increasing accessibility of mobile technologies and consumer-facing digital devices to empower patients in monitoring their own health outside of the hospital setting. The iGetBetter system, a secure Web- and telephone-based heart failure remote monitoring program, which leverages mobile technology and portable digital devices, offers a creative solution at lower cost. OBJECTIVE: The objective of this pilot study was to evaluate the feasibility of using the iGetBetter system for disease self-management in patients with heart failure. METHODS: This was a single-arm prospective study in which 21 ambulatory, adult heart failure patients used the intervention for heart failure self-management over a 90-day study period. Patients were instructed to take their weight, blood pressure, and heart rate measurements each morning using a WS-30 bluetooth weight scale, a self-inflating blood pressure cuff (Withings LLC, Issy les Moulineaux, France), and an iPad Mini tablet computer (Apple Inc, Cupertino, CA, USA) equipped with cellular Internet connectivity to view their measurements on the Internet. Outcomes assessed included usability and satisfaction, engagement with the intervention, hospital resource utilization, and heart failure-related quality of life. Descriptive statistics were used to summarize data, and matched controls identified from the electronic medical record were used as comparison for evaluating hospitalizations. RESULTS: There were 20 participants (mean age 53 years) that completed the study. Almost all participants (19/20, 95%) reported feeling more connected to their health care team and more confident in performing care plan activities, and 18/20 (90%) felt better prepared to start discussions about their health with their doctor. Although heart failure-related quality of life improved from baseline, it was not statistically significant (P=.55). Over half of the participants had greater than 80% (72/90 days) weekly and overall engagement with the program, and 15% (3/20) used the interactive voice response telephone system exclusively for managing their care plan. Hospital utilization did not differ in the intervention group compared to the control group (planned hospitalizations P=.23, and unplanned hospitalizations P=.99). Intervention participants recorded shorter average length of hospital stay, but no significant differences were observed between intervention and control groups (P=.30). CONCLUSIONS: This pilot study demonstrated the feasibility of a low-intensive remote monitoring program leveraging commonly used mobile and portable consumer devices in augmenting care for a fairly young population of ambulatory patients with heart failure. Further prospective studies with a larger sample size and within more diverse patient populations is necessary to determine the effect of mobile-based remote monitoring programs such as the iGetBetter system on clinical outcomes in heart failure.

Progressive ventricular dysfunction among nonresponders to cardiac resynchronization therapy: baseline predictors and associated clinical outcomes.

BACKGROUND: Cardiac resynchronization therapy (CRT) nonresponders have poor outcomes. The significance of progressive ventricular dysfunction among nonresponders remains unclear. OBJECTIVE: We sought to define predictors of and clinical outcomes associated with progressive ventricular dysfunction despite CRT. METHODS: We conducted an analysis of 328 patients undergoing CRT with defibrillator for standard indications. On the basis of 6-month echocardiograms, we classified patients as responders (those with a ≥5% increase in ejection fraction) and progressors (those with a ≥5% decrease in ejection fraction), and all others were defined as nonprogressors. Coprimary end points were 3-year (1) heart failure, left ventricular assist device (LVAD), transplantation, or death and (2) ventricular tachycardia (VT) or ventricular fibrillation (VF). RESULTS: Multivariable predictors of progressive ventricular dysfunction were aldosterone antagonist use (hazard ratio [HR] 0.23; P = .008), prior valve surgery (HR 3.3; P = .005), and QRS duration (HR 0.98; P = .02). More favorable changes in ventricular function were associated with lower incidences of heart failure, LVAD, transplantation, or death (70% vs 54% vs 33%; P < .0001) and VT or VF (66% vs 38% vs 28%; P = .001) for progressors, nonprogressors, and responders, respectively. After multivariable adjustment, progressors remained at increased risk of heart failure, LVAD, transplantation, or death (HR 2.14; P = .0029) and VT or VF (HR 2.03; P = .046) as compared with nonprogressors. Responders were at decreased risk of heart failure, LVAD, transplantation, or death (HR 0.44; P < .0001) and VT or VF (0.51; P = .015) as compared with nonprogressors. CONCLUSION: Patients with progressive deterioration in ventricular function despite CRT represent a high-risk group of nonresponders at increased risk of worsened clinical outcomes.

Usefulness and consequences of cardiac resynchronization therapy in dialysis-dependent patients with heart failure.

Cardiac resynchronization therapy (CRT) is often deferred in dialysis-dependent patients with heart failure (HF) because of a perceived lack of benefit and potentially higher risks, although the outcomes associated with CRT in dialysis have not been reported. We therefore studied our center's experience with CRT in dialysis-dependent patients. We constructed a descriptive assessment of these patients (n = 15) and performed a case-control analysis matching for age, gender, bundle branch morphology, diabetes mellitus, cardiomyopathy origin, and ß-blocker and angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use. Baseline and 6-month echocardiograms were assessed for evidence of reverse remodeling. No periprocedural or long-term complications were observed among dialysis patients. Heterogenous improvement in ejection fraction (+3.1 ± 9.2%) was noted and 2 patients derived absolute improvements of 8% and 22%, respectively. Dialysis patients demonstrated the following 3-year event rates: HF hospitalization, 31%; all-cause hospitalization, 100%; mortality, 73%; and HF hospitalization or death, 82%. In the case-control analysis, controls demonstrated superior reverse remodeling (+9.2 ± 9.5% increase in ejection fraction), decreased mortality (73% vs 44%, p = 0.038), and all-cause hospitalizations (76% vs 100%, p = 0.047), with no difference in HF hospitalizations (p = 0.39), compared with dialysis patients. In conclusion, at our center, the dialysis-dependent patients with HF who underwent CRT implantation did so safely and no serious complications were observed. Certain dialysis patients demonstrated compelling improvement after device implantation. Compared with matched controls, dialysis patients were at increased risk for adverse events and worsened echocardiographic outcomes.

Photophysical behaviour of cyclometalated iridium(III) complexes with phosphino(terthiophene) ligands.

Six new Ir(III) complexes containing the 3'-phosphino-2,2':5',2''-terthiophene (PT3) ligand in three different coordination modes are reported. The electronic properties of the complexes are characterized by cyclic voltammetry, absorption, emission and time-resolved transient absorption spectroscopies and DFT/TDDFT calculations. The electrochemical and photophysical behaviour of the complexes was found to be dominated by the PT3 ligand. For the complexes in which the PT3 ligand is coordinated in a bidentate P,S or P,C mode, the lowest energy absorption band is attributed to π-π* PT3 localized transitions consistent with observations from DFT calculations. Emission quantum yields are low in all cases (<0.07) and emission lifetimes are short (<50 ns). Intersystem crossing leads to a long-lived triplet state ((3)L) also localized on the PT3 group. In the complex where the PT3 ligand is coordinated only via the phosphine, TDDFT calculations suggest that there is some MLCT (and Cl-PT3 CT) character in the lowest energy transition.