Self-Perceived Barriers and Facilitators to Dietary Approaches to Stop Hypertension Diet Adherence Among Black Americans With Chronic Kidney Disease: A Qualitative Study.

OBJECTIVE: The Dietary Approaches to Stop Hypertension (DASH) eating plan improves hypertension in Black individuals and is associated with favorable chronic kidney disease (CKD) outcomes. Yet, adherence to DASH is low among US adults in general, particularly among Black Americans. We assessed perceptions about DASH, its cultural compatibility, and barriers and facilitators to DASH adherence in Black adults with CKD. DESIGN AND METHODS: We conducted focus groups and semistructured individual interviews involving 22 Black men and women with CKD Stages 3-4 from outpatient clinics at a US academic medical center. Transcripts of audio-recorded interviews were analyzed using thematic analysis. RESULTS: Among participants (2 focus groups [N = 8 and 5] and 9 individual interviews), 13 (59%) had CKD Stage 3, 13 (59%) were female, the median age was 61 years, and 19 (90%) had hypertension. After receiving information about DASH, participants perceived it as culturally compatible based on 3 emergent themes: (1) Black individuals already eat DASH-recommended foods ("Blacks eat pretty much like this"), (2) traditional recipes (e.g., southern or soul food) can be modified into healthy versions ("you can come up with decent substitutes to make it just as good"), and ( 3) diet is not uniform among Black individuals ("I can't say that I eat traditional"). Perceived barriers to DASH adherence included unfamiliarity with serving sizes, poor cooking skills, unsupportive household members, and high cost of healthy food. Eleven (52%) reported after paying monthly bills that they "rarely" or "never" had leftover money to purchase healthy food. Perceived facilitators included having local access to healthy food, living alone or with supportive household members, and having willpower and internal/external motivation for change. CONCLUSIONS: Black adults with CKD viewed DASH as a healthy, culturally compatible diet. Recognizing that diet in Black adults is not uniform, interventions should emphasize person-centered, rather than stereotypically culture-centered, approaches to DASH adherence.

Effects of Smoking Reduction and Cessation on Birth Outcomes in a Scheduled Gradual Reduction Cessation Trial.

INTRODUCTION: Smoking during pregnancy can affect infant birthweight. We tested whether an intervention that promoted scheduled gradual reduction improved birth outcomes among pregnant women who smoked. We also examined race differences in birth outcomes. METHODS: We conducted a 2-arm randomized controlled trial where pregnant women who smoked received either SMS text-delivered scheduled gradual smoking reduction (SGR) program plus support texts or support messages only throughout their pregnancy. The outcomes for this paper were birth outcomes including birth weight and gestational age obtained from chart review. Analyses were conducted using chi-square and t-tests in SAS. RESULTS: We approached 2201 pregnant women with smoking history. Of the 314 women recruited into the study, 290 completed a medical release form (92%). We did not find any significant differences in birth outcomes by arm or race. The majority of participants reduced smoking by the 80%. Women who reduced more than 50% of their baseline cigarettes per day had a birth weight increase of 335 g compared to those that did not (p = 0.05). The presence of alcohol/drug use in prenatal visit notes was associated with low infant birth weight (p = 0.05). DISCUSSION: The scheduled gradual reduction intervention did not improve birth outcomes. Additional research is needed to help improve birth outcomes for pregnant women who engage in tobacco and illicit substance use. CLINICAL TRIAL #: NCT01995097.

Trajectories of Situational Temptations in Pregnant Smokers participating in a Scheduled Gradual Reduction Cessation Trial.

OBJECTIVE: The purpose of this paper was to examine changes in situational temptations to smoke among women in early to late pregnancy enrolled in a texting trial to help them quit smoking. We compared changes between (1) intervention arms, (2) those who quit, (3) those who reduced by 50% or more, and (4) those who reduced by less than 50%. We also examined cravings overtime in the intervention arm and the relationship between real-time cravings assessed via text message and situational temptations. METHODS: This was a secondary analysis of the Baby Steps trial, a randomized controlled trial testing the efficacy of a text-based scheduled gradual reduction (SGR) intervention on cessation. We used t-tests to examine changes across intervention arms and repeated measured proc mixed to explore changes in situational temptations and cravings. RESULTS: Among all women, situational temptations decreased from early to late pregnancy for the positive, negative, and habitual subscales, (ps < 0.001). We found no difference in situational temptations across arms. We found a positive relationship between negative situational temptation and average craving during the Weeks 2 and Weeks 3 of the intervention. Negative ST increased by 0.11 for each unit increase of craving at Week 2. CONCLUSIONS: As women progress through pregnancy their temptation to smoke reduces. A different relationship might exist, however with negative affect situations in which women reported higher craving but not in response to other temptations. Future work might have a particular focus on the intersection of negative affect with cravings and temptations to promote cessation during pregnancy. CLINICAL TRIAL: NCT01995097.

Pilot Test of Connecting Pregnant Women who Smoke to Short Message Service (SMS) Support Texts for Cessation.

INTRODUCTION: Most pregnant women know that smoking poses serious risks to baby and mother, yet many still smoke. We conducted a large randomized controlled trial and found that an SMS text-delivered program helped about 10% of these women quit smoking. In this paper, we describe the feasibility of disseminating a text-based intervention to pregnant women who smoke. METHODS: We tested dissemination in two ways from prenatal clinics and compared recruitment rates to those found in our large randomized controlled trial. The first method involved "direct texting" where study staff identified women who smoked and sent them a text asking them to text back if they wanted to receive texts to help them quit. The second involved "nurse screening" where clinic staff from county health departments screened women for smoking and asked them to send a text to the system if they wanted to learn more about the program. Our primary outcome was feasibility assessed by the number of women who texted back their baby's due date, which served as "enrolling" in the texting program, which we compared to the recruitment rate we found in our large trial. RESULTS: Over 4 months, we texted 91 women from the academic health system. Of those, 17 texted back and were counted as "enrolled." In the health departments, across the 4 months, 12 women texted the system initially. Of those, 10 were enrolled. This rate was similar to the rate enrolled in the randomized controlled trial. DISCUSSION: Two different methods connected pregnant women who smoke to a texting program. One of these methods can be automated further and have the potential of helping many women quit smoking with minimal effort. Clinical Trial # NCT01995097.

The Role of Mental Health Disease in Potentially Preventable Hospitalizations: Findings From a Large State.

BACKGROUND: Preventable hospitalizations are markers of potentially low-value care. Addressing the problem requires understanding their contributing factors. OBJECTIVE: The objective of this study is to determine the correlation between specific mental health diseases and each potentially preventable hospitalization as defined by the Agency for Healthcare Research and Quality. DESIGN/SUBJECTS: The Texas Inpatient Public Use Data File, an administrative database of all Texas hospital admissions, identified 7,351,476 adult acute care hospitalizations between 2005 and 2008. MEASURES: A hierarchical multivariable logistic regression model clustered by admitting hospital adjusted for patient and hospital factors and admission date. RESULTS: A total of 945,280 (12.9%) hospitalizations were potentially preventable, generating $6.3 billion in charges and 1.2 million hospital days per year. Mental health diseases [odds ratio (OR), 1.25; 95% confidence interval (CI), 1.22-1.27] and substance use disorders (OR, 1.13; 95% CI, 1.12-1.13) both increased odds that a hospitalization was potentially preventable. However, each mental health disease varied from increasing or decreasing the odds of potentially preventable hospitalization depending on which of the 12 preventable hospitalization diagnoses were examined. Older age (OR, 3.69; 95% CI, 3.66-3.72 for age above 75 years compared with 18-44 y), black race (OR 1.44; 95% CI, 1.43-1.45 compared to white), being uninsured (OR 1.52; 95% CI, 1.51-1.54) or dual-eligible for both Medicare and Medicaid (OR, 1.23; 95% CI, 1.22-1.24) compared with privately insured, and living in a low-income area (OR, 1.20; 95% CI, 1.17-1.23 for lowest income quartile compared with highest) were other patient factors associated with potentially preventable hospitalizations. CONCLUSIONS: Better coordination of preventative care for mental health disease may decrease potentially preventable hospitalizations.

Gas-separation membranes loaded with porous aromatic frameworks that improve with age.

Porosity loss, also known as physical aging, in glassy polymers hampers their long term use in gas separations. Unprecedented interactions of porous aromatic frameworks (PAFs) with these polymers offer the potential to control and exploit physical aging for drastically enhanced separation efficiency. PAF-1 is used in the archetypal polymer of intrinsic microporosity (PIM), PIM-1, to achieve three significant outcomes. 1) hydrogen permeability is drastically enhanced by 375% to 5500 Barrer. 2) Physical aging is controlled causing the selectivity for H2 over N2 to increase from 4.5 to 13 over 400 days of aging. 3) The improvement with age of the membrane is exploited to recover up to 98% of H2 from gas mixtures with N2 . This process is critical for the use of ammonia as a H2 storage medium. The tethering of polymer side chains within PAF-1 pores is responsible for maintaining H2 transport pathways, whilst the larger N2 pathways gradually collapse.

High-throughput development of amphiphile self-assembly materials: fast-tracking synthesis, characterization, formulation, application, and understanding.

Amphiphile self-assembly materials, which contain both a hydrophilic and a hydrophobic domain, have great potential in high-throughput and combinatorial approaches to discovery and development. However, the materials chemistry community has not embraced these ideas to anywhere near the extent that the medicinal chemistry community has. While this situation is beginning to change, extracting the full potential of high-throughput approaches in the development of self-assembling materials will require further development in the synthesis, characterization, formulation, and application domains. One of the key factors that make small molecule amphiphiles prospective building blocks for next generation multifunctional materials is their ability to self-assemble into complex nanostructures through low-energy transformations. Scientists can potentially tune, control, and functionalize these structures, but only after establishing their inherent properties. Because both robotic materials handling and customized rapid characterization equipment are increasingly available, high-throughput solutions are now attainable. These address traditional development bottlenecks associated with self-assembling amphiphile materials, such as their structural characterization and the assessment of end-use functional performance. A high-throughput methodology can help streamline materials development workflows, in accord with existing high-throughput discovery pipelines such as those used by the pharmaceutical industry in drug discovery. Chemists have identified several areas that are amenable to a high-throughput approach for amphiphile self-assembly materials development. These allow an exploration of not only a large potential chemical, compositional, and structural space, but also material properties, formulation, and application variables. These areas of development include materials synthesis and preparation, formulation, characterization, and screening performance for the desired end application. High-throughput data analysis is crucial at all stages to keep pace with data collection. In this Account, we describe high-throughput advances in the field of amphiphile self-assembly, focusing on nanostructured lyotropic liquid crystalline materials, which form when amphiphiles are added to a polar solvent. We outline recent progress in the automated preparation of amphiphile molecules and their nanostructured self-assembly systems both in the bulk phase and in dispersed colloidal particulate systems. Once prepared, we can structurally characterize these systems by establishing phase behavior in a high-throughput manner with both laboratory (infrared and light polarization microscopy) and synchrotron facilities (small-angle X-ray scattering). Additionally, we provide three case studies to demonstrate how chemists can use high-throughput approaches to evaluate the functional performance of amphiphile self-assembly materials. The high-throughput methodology for the set-up and characterization of large matrix in meso membrane protein crystallization trials can illustrate an application of bulk phase self-assembling amphiphiles. For dispersed colloidal systems, two nanomedicine examples highlight advances in high-throughput preparation, characterization, and evaluation: drug delivery and magnetic resonance imaging agents.

Lyotropic liquid crystal phases of phytantriol in a protic ionic liquid with fluorous anion.

The phase behaviour of phytantriol in the protic ionic liquid (PIL) 1-methylimidazolium pentadecafluorooctanoate (MImOF) and four different MImOF-water compositions was investigated by small- and wide-angle X-ray scattering (SAXS/WAXS), cross polarised optical microscopy (CPOM) and infrared spectroscopy (IR). MImOF is a distinct protic ionic liquid in that it contains a fluorocarbon anion and a hydrocarbon cation. This leads to MImOF having an unusual liquid nanostructure, such that it contains fluorocarbon, hydrocarbon and polar domains. No lyotropic liquid crystal phases were observed for phytantriol in neat MImOF. However, on addition of water, lamellar, cubic Ia3¯d and micellar phases were observed for specific MImOF-phytantriol-water compositions at room temperature, and up to 60 °C. The phase behaviour for phytantriol in the solvent mixture of 25 wt%-MImOF-75 wt%-water was the most similar to the phytantriol-water phase diagram. Only this MImOF-water composition supported the Ia3¯d cubic phase, which had a lattice parameter between 100-140 Å compared to 86-100 Å in deionised water, indicating significant swelling due to the MImOF. IR spectroscopy showed that a percentage of the water molecules were hydrogen bonded to the N-H of the MIm cation, and this water decreased the hydrogen bonding present between the cation and anion of the ionic liquid. This investigation furthers our understanding of the interaction of ionic liquids with solutes, and the important role that the different IL nanostructures can have on influencing these interactions.

Fluorous protic ionic liquids exhibit discrete segregated nano-scale solvent domains and form new populations of nano-scale objects upon primary alcohol addition.

Fluorous protic ionic liquids (FPILS) containing a perfluorinated anion and hydrocarbon cation have been observed to segregate into nano-scale fluorocarbon, hydrocarbon and polar domains. The solubility and interactions of ethanol and butanol in a series of FPILs has been investigated by synchrotron source small and wide angle X-ray scattering. Nano-scale objects were found to be present within the binary solutions from low concentrations of FPILs in alcohols to around 40 to 80 wt% FPIL. The FPILs retain their fluorocarbon, hydrocarbon and polar domains in binary mixtures with alcohols in addition to the formation of nano-scale alcohol associated objects. For comparison, the influence of alcohols on the nano-scale segregation of analogous protic ionic liquids (PILs) which contained hydrocarbon anions in place of the perfluorinated anions was also investigated. The ethanol and butanol were miscible with the PILs across the full concentration range, with no evidence for the formation of analogous nano-scale objects. The FPILs are prospective solvents which may enable simultaneous solubility of fluorocarbon, hydrocarbon and polar species.

Protic ionic liquids with fluorous anions: physicochemical properties and self-assembly nanostructure.

A series of 11 new protic ionic liquids with fluorous anions (FPILs) have been identified and their self-assembled nanostructure, thermal phase transitions and physicochemical properties were investigated. To the best of our knowledge this is the first time that fluorocarbon domains have been reported in PILs. The FPILs were prepared from a range of hydrocarbon alkyl and heterocyclic amine cations in combination with the perfluorinated anions heptafluorobutyrate and pentadecafluorooctanoate. The nanostructure of the FPILs was established by using small- and wide-angle X-ray scattering (SAXS and WAXS). In the liquid state many of the FPILs showed an intermediate range order, or self-assembled nanostructure, resulting from segregation of the polar and nonpolar hydrocarbon and fluorocarbon domains of the ionic liquid. In addition, the physicochemical properties of the FPILs were determined including the melting point (T(m)), glass transition (T(g)), devitrification temperature (T(c)), thermal stability and the density ρ, viscosity η, air/liquid surface tension γ(LV), refractive index n(D), and ionic conductivity κ. The FPILs were mostly solids at room temperature, however two examples 2-pyrrolidinonium heptafluorobutyrate (PyrroBF) and pyrrolidinium heptafluorobutyrate (PyrrBF) were liquids at room temperature and all of the FPILs melted below 80 °C. Four of the FPILs exhibited a glass transition. The two liquids at room temperature, PyrroBF and PyrrBF, had a similar density, surface tension and refractive index but their viscosity and ionic conductivity were very different due to dissimilar self-assembled nanostructure.

Biological, Behavioral, and Ethical Considerations of Prader-Willi Syndrome: A Primer for Behavior Analysts.

Prader-Willi syndrome (PWS) is a rare genetic disorder typically characterized by hyperphagia, hypotonia, intellectual disabilities, insistence on routines, and obsession and compulsion related to food. Although current medical interventions primarily include growth hormones to address the biological symptoms of the individual, behavioral therapy is an alternative option for skill acquisition and decreasing problem behaviors. There is a growing need for applied behavior analysis (ABA) research on targeting problem behaviors and teaching requisite skills to individuals with this syndrome. This article reviews the current literature on PWS, highlights treatments and their limitations, suggests how ABA providers can provide ethical services, and proposes future research needs with this syndrome.

Assessing the feasibility and acceptability of a peer-based communication coaching model among hospital clinicians.

Objective: Communication coaching shows promise for improving clinician communication yet few have assessed the feasibility of having peers coach each other. We conducted a proof-of-concept study to test the feasibility and acceptability of a peer-based communication coaching program in an inpatient setting. Methods: We trained three clinician communication coaches (two physicians and one physician assistant) and randomized half of the 27 clinicians working on the general medicine floor to receive coaching. The coaching involved shadowing and providing feedback on real-time encounters with patients. We collected data on feasibility of providing the coaching, quantitative and qualitative ratings of acceptability of the coaching both from the clinician and the coach perspective, and clinician burnout. Results: We found the peer coaching to be feasible and acceptable. Quantitative and qualitative reports support the merit of the coaching; most clinicians who received the coaching reported making changes in their communication. Clinicians in the intervention arm reported less burnout than those who did not receive the coaching. Conclusions: This proof-of-concept pilot showed that peer coaches can provide communication coaching and that clinicians and coaches viewed the coaching as acceptable and might change communication. The coaching also seems to show promise on burnout. We provide lessons learned and thoughts about how to improve the program. Innovation: Teaching clinicians to coach each other is innovative. We conducted a pilot that shows promise for feasibility, acceptability of clinicians coaching each other to communicate better, and a signal that it can help improve clinician burnout.

Characteristics Associated with Burnout among Cardiologists in an Academic Medical Setting: Baseline Survey Results from a Communication Coaching RCT.

OBJECTIVES: Clinician burnout poses risks not just to clinicians but also to patients and the health system. Cardiologists might be especially prone to burnout due to performing high-risk procedures, having to discuss serious news, and treating diseases that incur significant morbidity and mortality. Few have attempted to examine which cardiologists might be at higher risk of burnout. Knowing at-risk cardiologists can help frame resilience interventions. METHODS: We enrolled 41 cardiologists across five ambulatory cardiology clinics into a randomized controlled trial where we assessed the Maslach Burnout Inventory at baseline. We used bivariate analyses to assess associations between cardiologist demographics and burnout. RESULTS: Cardiologists reported low burnout for depersonalization and personal accomplishment and moderate levels for emotional exhaustion. Female cardiologists reported emotional exhaustion scores in the "low" range (M = 12.3; SD = 10.06), compared to male cardiologists whose score was in the "moderate" range 19.6 (SD = 9.59; p = 0.113). Cardiologists who had greater than 15 years in practice reported higher mean scores of emotional exhaustion, indicating moderate burnout (M = 20.0, SD = 10.63), compared to those with less than 15 years in practice (M = 16.6, SD = 9.10; p = 0.271). CONCLUSIONS: In this sample, unlike prior studies, male cardiologists reported more burnout. Consistent with prior work, mid-level cardiologists might be at highest risk of emotional exhaustion.

LATIN-19: A Grassroots Coalition to Mitigate the Effect of COVID-19 on the Latinx Community in North Carolina.

BACKGROUND: Social inequity is a primary driver of health disparities, creating multiple barriers to good health. These inequities were exacerbated during the coronavirus disease 2019 (COVID-19) pandemic, with Latinx communities suffering more than others. Grassroots collaborations have long existed to address disparities. OBJECTIVE: We describe the creation and work of the Latinx Advocacy Team and Interdisciplinary Network for COVID-19 (LATIN-19; http://latin19.org/), a multisector coalition in North Carolina created to address the unique challenges of COVID-19 in the Latinx community. METHODS: We discuss challenges and solutions that LATIN-19 addressed and the impact of LATIN-19 on community partners and members. RESULTS: LATIN-19 learned of challenges including, lack of awareness, need for data systems to track disparities, the need to increase access to resources, the need for policy changes, and the need to coordinate services by community organizations. CONCLUSIONS: LATIN-19 represents a grassroots organization that has had an impact on community and community organizations that spans beyond COVID-19.

Nanostructure changes in protic ionic liquids (PILs) through adding solutes and mixing PILs.

The effect of adding primary n-alcohols with aliphatic chains and hexane on the nanostructure of a series of 14 protic ionic liquids (PILs) was explored using small and wide angle X-ray scattering (SAXS and WAXS). PILs were investigated with primary, secondary and tertiary ammonium cations containing different alkyl chain lengths, with and without hydroxyl substitution of the alkyl chain. Formate or nitrate anions were paired with these cations. The PILs which had no identified intermediate range order between 5-16 Å had very low solubilities of the solutes. The other PILs, which had non-polar domains present, were mostly miscible with the primary alcohols of ethanol, propanol and butanol. When the alkyl chain length of the alcohols was similar to the PILs then the alcohols co-partitioned with the alkylammonium cation components of the PILs and caused either an increase or decrease in the size of the non-polar domains, depending on whether the alcohol chain length was longer or shorter than that of the cation in the PIL respectively. For ethylammonium nitrate (EAN) with propanol or butanol and propylammonium nitrate (PAN) with butanol, the difference between the alcohol chain length and the alkyl chain length was too great to lead to a modified nanostructure, and instead large aggregates were present. The solubility of hexane in the alkylammonium nitrate PILs had a very strong correlation to the alkyl chain length. The addition of hexane had very little effect on the non-polar domain sizes, which was attributed to it not being orientated in alignment with the alkylammonium cations in the non-polar domains. Lastly, seven binary PIL-PIL solution series were investigated using SAXS and WAXS to show how the nanostructure of these systems can be fine tuned to control the size and structure of the non-polar domains.

Cue-based treatment for light smokers: A proof of concept pilot.

INTRODUCTION: Light smoking (smoking ≤ 10 cigarettes per day or on some days) has become increasingly prevalent in the US and increases morbidity and mortality. Many light smokers do not experience significant nicotine withdrawal but instead smoke in response to cues. Minimal evidence exists supporting interventions to help light smokers quit smoking. METHODS: We present results from a proof-of-concept pilot study designed to evaluate the feasibility and acceptability of a cue-based smoking cessation intervention targeted to light daily and intermittent smokers. Participants were randomized to one of two arms: Arm 1) standard smoking cessation treatment or Arm 2) standard smoking cessation treatment + enhanced cue-based treatment that included interactive texting to extend cue exposure treatment to real-world settings and cue management counseling.Outcomes included feasibility (number of participants who were recruited and who completed the intervention), acceptability (intervention ratings), and preliminary efficacy (7-day point prevalence abstinence). RESULTS: We randomized 24 English and Spanish-speaking light smokers, 13 to the treatment arm and 11 to the control arm. Across both arms, 77% attended all counseling sessions, 90% rated these sessions as very useful and 100% said that they would recommend the intervention to a friend. 15% in the treatment arm had biochemically-validated smoking abstinence compared to 0% in the standard counseling arm. CONCLUSIONS: Results from this proof-of-concept study demonstrated that a cue-based intervention is feasible and acceptable among light smokers and suggests the need for a fully powered study to assess this approach. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT03416621.

Communication Coaching in Cardiology (CCC): A study protocol and methodological challenges and solutions of a randomized controlled trial in outpatient cardiology clinics.

Given the role of effective communication in improving patient adherence and satisfaction, high quality patient-clinician communication is critical. Building on previous communication interventions in oncology and pediatrics, we developed a tailored communication coaching intervention to improve empathic communication quality and patient-centered care. In this randomized controlled trial, cardiologists record their patient encounters for review by a communication coach who provides tailored feedback. We are recruiting 40 cardiologists and 400 patients, or 4 patients per cardiologist in the Pre-intervention phase and 6 patients per cardiologists in the Post-intervention phase, from outpatient cardiology clinics within the Duke Health System. The primary goal of the trial is to determine the efficacy of the clinician communication coaching versus usual care in the post-intervention phase (240 patient encounters). In this paper, we describe the development of the communication coaching intervention. We also describe the details of the methods and outcomes of the ongoing trial. Finally, we discuss the challenges, solutions, and lessons learned during the start-up phase of the study.

A Yet Unrealized Promise: Structured Advance Care Planning Elements in the Electronic Health Record.

Background: Electronic health records (EHRs) may help enable reliable, rapid data management for many uses, such as facilitating communication of advance care planning (ACP). However, issues with validity and accuracy of EHRs hinder the use of ACP information for practical applications. Design: We present a cross-sectional pilot study of 433 older adults with cancer from three large health care systems, participating in an ongoing multisite pragmatic trial (4UH3AG060626-02). We compared data extracted from dedicated structured EHR fields for ACP to a chart review of corresponding ACP documentation contained in the medical chart. Results: Structured ACP data existed for 43.2% of patients and varied by site (25.7% -48.9%). Of the identified structured ACP data elements, 59.2% of recorded elements were correct, 23.7% were incorrect, and 17.1% were duplicates with heterogeneity across sites. Conclusion: Structured ACP data in EHRs were frequently incorrect. This represents a problem for patients and their families, as well as quality improvement and research efforts. Clinical Trials Registration: NCT03609177.

Nanostructured nonionic thymidine nucleolipid self-assembly materials.

Three nucleoside lipids have been synthesized: 3'-oleoylthymidine, 3',5'-dioleoylthymidine, and 3'-phytanoylthymidine. Differential scanning calorimetry and X-ray diffraction have been employed to characterize the physical properties of these neat lipids. Polarizing optical microscopy, small-angle X-ray scattering, and cryo-transmission electron microscopy techniques have been used to investigate the phase behavior in aqueous systems. Both oleoyl-based nucleoside lipids adopted a lamellar crystalline phase in the neat form at room temperature, and the phytanoyl derivative exhibited a fluid isotropic phase. Under excess water conditions, the presence of one branched (phytanoyl) or one unsaturated (oleoyl) chain promoted the formation of a liquid-crystalline lamellar phase at physiological temperatures. In contrast, the 3',5'-dioleoylthymidine derivative is nonswelling and does not exhibit lyotropic liquid-crystalline phase behavior. The nucleolipids' propensity for DNA-type binding and recognition has been evaluated by using a monolayer system to measure surface pressure-area isotherms in a Langmuir trough and indicates that the nucleoside base is available for nonspecific hydrogen bonding in the monolayer liquid expanded state for the single-chain nucleolipids but not for the dual-chain amphiphile.

Lanthanide phytanates: liquid-crystalline phase behavior, colloidal particle dispersions, and potential as medical imaging agents.

Lanthanide salts of phytanic acid, an isoprenoid-type amphiphile, have been synthesized and characterized. Elemental analysis and FTIR spectroscopy were used to confirm the formed product and showed that three phytanate anions are complexed with one lanthanide cation. The physicochemical properties of the lanthanide phytanates were investigated using DSC, XRD, SAXS, and cross-polarized optical microscopy. Several of the hydrated salts form a liquid-crystalline hexagonal columnar mesophase at room temperature, and samarium(III) phytanate forms this phase even in the absence of water. Select lanthanide phytanates were dispersed in water, and cryo-TEM images indicate that some structure has been retained in the dispersed phase. NMR relaxivity measurements were conducted on these systems. It has been shown that a particulate dispersion of gadolinium(III) phytanate displays proton relaxivity values comparable to those of a commercial contrast agent for magnetic resonance imaging and a colloidal dispersion of europium(III) phytanate exhibits the characteristics of a fluorescence imaging agent.