Urine output is an early and strong predictor of acute kidney injury and associated mortality: a systematic literature review of 50 clinical studies.

BACKGROUND: Although the present diagnosis of acute kidney injury (AKI) involves measurement of acute increases in serum creatinine (SC) and reduced urine output (UO), measurement of UO is underutilized for diagnosis of AKI in clinical practice. The purpose of this investigation was to conduct a systematic literature review of published studies that evaluate both UO and SC in the detection of AKI to better understand incidence, healthcare resource use, and mortality in relation to these diagnostic measures and how these outcomes may vary by population subtype. METHODS: The systematic literature review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Data were extracted from comparative studies focused on the diagnostic accuracy of UO and SC, relevant clinical outcomes, and resource usage. Quality and validity were assessed using the National Institute for Health and Care Excellence (NICE) single technology appraisal quality checklist for randomized controlled trials and the Newcastle-Ottawa Quality Assessment Scale for observational studies. RESULTS: A total of 1729 publications were screened, with 50 studies eligible for inclusion. A majority of studies (76%) used the Kidney Disease: Improving Global Outcomes (KDIGO) criteria to classify AKI and focused on the comparison of UO alone versus SC alone, while few studies analyzed a diagnosis of AKI based on the presence of both UO and SC, or the presence of at least one of UO or SC indicators. Of the included studies, 33% analyzed patients treated for cardiovascular diseases and 30% analyzed patients treated in a general intensive care unit. The use of UO criteria was more often associated with increased incidence of AKI (36%), than was the application of SC criteria (21%), which was consistent across the subgroup analyses performed. Furthermore, the use of UO criteria was associated with an earlier diagnosis of AKI (2.4-46.0 h). Both diagnostic modalities accurately predicted risk of AKI-related mortality. CONCLUSIONS: Evidence suggests that the inclusion of UO criteria provides substantial diagnostic and prognostic value to the detection of AKI.

Electrostatic Correlations Lead to High Capacitance in Zwitterion-Containing Thin Films.

A novel zwitterion composed of an imidazolium tethered to an anionic sulfonyl(trifluoromethane sulfonyl)imide group was prepared as an alternative dielectric material to traditional ionic liquids. The zwitterion not only melted below 100 °C but also proved to be nonhygroscopic. High-capacitance organic dielectric materials were obtained by blending this compound with poly(methyl methacrylate) over a range of concentrations and thicknesses. Above a specific temperature and concentration, films exhibit a capacitance nearly equivalent to that of an electrostatic double layer, approximately 10 µF/cm2, regardless of their thickness. Grazing-incidence wide-angle X-ray scattering experiments suggest that the zwitterions adopt a lamellar ordering at their surface above a critical concentration. The observed ordering is correlated with a 1000-fold increase in capacitance. The behavior suggests that the zwitterions exhibit strong electrostatic correlations throughout the film bulk, pointing the way toward a novel class of organic dielectric materials.

Bereavement scheduling policy for emergency medicine residents: A descriptive pilot study.

Background: The Accreditation Council for Graduate Medical Education has tasked residency programs to prioritize resident wellness, reduce trainee stress, and prevent burnout. Grief and bereavement can significantly impact residents' wellness during difficult clinical training schedules. There are no best practices on how to support residents during this time. Methods: In a split academic county emergency medicine (EM) residency, this pilot study documents a resident-driven change to scheduling practices for bereavement leave. An advisory group of residents, chief residents, and program directors informally polled peer institutions to develop bereavement leave guidelines. Considerations were made to balance resident wellness, education, and patient care in developing a bereavement scheduling policy. Results: The bereavement policy was adopted in January 2023, aiming to "support the resident during a difficult time and reduce concerns around shift coverage" following the death of a family member without impacting sick call. The number of covered days depended on the relationship of the resident to the deceased. Residents covering bereavement days for their peers were financially compensated. During the first 7 months following implementation, five residents utilized the policy. These residents noted this to be the most positive impact on the residency during the past year. Based on resident feedback, the scope was expanded to include grave medical illness of a family member as an implementation criterion. Conclusions: This article outlines the creation, implementation, and benefits of a bereavement scheduling policy within an EM residency. Describing this approach will provide guidance for other residencies to adopt similar wellness-focused strategies.

Opportunities to Enhance Diagnostic Testing and Antimicrobial Stewardship: A Qualitative Multinational Survey of Healthcare Professionals.

INTRODUCTION: Antimicrobial resistance (AMR) is a global public health challenge. Global efforts to decrease AMR through antimicrobial stewardship (AMS) initiatives include education and optimising the use of diagnostic technologies and antibiotics. Despite this, economic and societal challenges hinder AMS efforts. The objective of this study was to obtain insights from healthcare professionals (HCPs) on current challenges and identify opportunities for optimising diagnostic test utilisation and AMS efforts. METHODS: Three hundred HCPs from six countries (representing varied gross national incomes per capita, healthcare system structure, and AMR rates) were surveyed between November 2022 through January 2023. A targeted literature review and expert interviews were conducted to inform survey development. Descriptive statistics were used to summarise survey responses. RESULTS: These findings suggest that the greatest challenges to diagnostic test utilisation were economic in nature; many HCPs reported that AMS initiatives were lacking investment (32.3%) and resourcing (40.3%). High resistance rates were considered the greatest barriers to appropriate antimicrobial use (52.0%). Most HCPs found local and national guidelines to be very useful (≥ 51.0%), but areas for improvement were noted. The importance of AMS initiatives was confirmed; diagnostic practices were acknowledged to have a positive impact on decreasing AMR (70.3%) and improving patient outcomes (81.0%). CONCLUSION: AMS initiatives, including diagnostic technology utilisation, are pivotal to decreasing AMR rates. Interpretation of these survey results suggests that while HCPs consider diagnostic practices to be important in AMS efforts, several barriers to successful implementation still exist including patient/institutional costs, turnaround time of test results, resourcing, AMR burden, and education. While some barriers differ by country, these survey results highlight areas of opportunities in all countries for improved use of diagnostic technologies and broader AMS efforts, as perceived by HCPs. Greater investment, resourcing, education, and updated guidelines offer opportunities to further strengthen global AMS efforts.

Antimicrobials are medications used to treat infections caused by bacteria (e.g. antibiotics), viruses, parasites, and fungi. Over time, these microbes may become resistant to antimicrobials, limiting how well they work. This often happens as a result of overuse, using antimicrobials when there is not an infection, or using an inappropriate antimicrobial. Antimicrobial resistance is a growing global problem. Antimicrobial stewardship programs aim to improve appropriate use of antimicrobials. Diagnostic testing plays an important role in these programs by identifying the microbes responsible for infections so patients can be given the right treatment as quickly as possible. We aimed to obtain the perspective of healthcare professionals from six countries on the challenges of and ways to improve diagnostic testing and antimicrobial stewardship programs. We found that some of the greatest challenges were related to costs. Approximately one-third of participants said that antimicrobial stewardship initiatives were lacking investment (32.3%) and resourcing (40.3%). High rates of antimicrobial resistance were identified as the greatest barriers to appropriate antimicrobial use (52.0%). Participants said that diagnostic practices have a positive impact on decreasing antimicrobial resistance (70.3%) and improving patient outcomes (81.0%). Overall, we found that healthcare professionals consider diagnostic tests to be an important part of antimicrobial stewardship, but there are several barriers to their success, including patient/hospital costs, turnaround time of test results, resourcing, antimicrobial resistance, and education. To overcome these barriers, increased funding, education, and resourcing, regular guideline updates, and development of optimised testing algorithms may help to improve antimicrobial stewardship and ultimately decrease antimicrobial resistance.

Targeted Drug Delivery for the Treatment of Abdominal Pain in Chronic Pancreatitis: A Retrospective Case Series.

Abdominal pain secondary to chronic pancreatitis (CP) is difficult to manage and often requires chronic oral opioid therapy (OOT). Targeted drug delivery (TDD) allows for a diminished dose of opioid intake and improved pain levels. TDD has been used in different pain syndromes with only limited reports in CP. OBJECTIVE: The objective of this article is to perform a retrospective review of CP patients treated with TDD versus OOT to compare chronic pain control and consumed morphine-equivalent doses. METHODS: Patients receiving TDD between September 2011 and August 2018 were included. All patients were weaned off oral opioids one week before intrathecal trial and pump implantation. Patients with intrathecal trials providing at least 50% pain relief underwent pump implantation. Data were collected while on OOT and at two weeks, three months, and nine months post-implant. Data were analyzed with Microsoft Excel 365 MSO using means and standard deviations. P-values were calculated using a two-tailed student's t-test with paired two-sample means. RESULTS: Twenty-three patients were analyzed. Pre-trial average pain score was 6.5/10 with a mean improvement with trials greater than 71%. The mean chronic baseline oral morphine milligram equivalents (MME) was 188. The mean MME on TDD at two weeks (0.36), three months (1.39), and nine months (2.47) were significantly lower than OOT. Mean pain scores were 6, 4.9, and 5.6 at two weeks, three months, and nine months, respectively, compared to 6.5 on OOT. DISCUSSION: The results of this study indicate that TDD provides improved pain control with significantly lower opioid doses.

Peripartum Cardiac Arrest with Terminal QRS Distortion: A Case Report.

Introduction: Peripartum cardiac arrest is increasing in incidence. While pulmonary embolism (PE) remains an important cause of peripartum morbidity and mortality, other cardiovascular emergencies such as myocardial infarction (MI) are now the leading cause of pregnancy-related death. Emergency physicians (EP) need to be well versed in subtle electrocardiographic (ECG) signs of coronary ischemia to better care for peripartum patients in cardiac arrest. Case Report: A 38-year-old gravida 2 parity1 female three days post-partum presented in cardiac arrest. After approximately 12 minutes of Advanced Cardiac Life Support including electric defibrillation, the patient experienced sustained return of spontaneous circulation. The physician team was primarily concerned for PE based on an initial ECG demonstrating terminal QRS distortion in V2 but no ST-segment elevation myocardial infarction (STEMI). Computed tomography angiography (CTA) of the chest did not reveal PE. Repeat ECG after CTA demonstrated STEMI criteria, and the patient was emergently taken to the cardiac catheterization laboratory where she was found to have 99% occlusion of the left anterior descending artery. Conclusion: Emergency physicians should have a high index of suspicion for MI when managing peripartum patients in cardiac arrest. The ECG findings specific for coronary-occlusive acute MI but not included in the classic STEMI criteria increase accuracy and prevent delays in diagnosis; however, the clinical uptake of this paradigm has been slow. Early recognition of terminal QRS distortion can help EPs more rapidly diagnose the etiology of cardiac arrest.

Catheter-associated urinary tract infections (CAUTIs) and non-CAUTI hospital-onset urinary tract infections: Relative burden, cost, outcomes and related hospital-onset bacteremia and fungemia infections.

OBJECTIVE: To describe the relative burden of catheter-associated urinary tract infections (CAUTIs) and non-CAUTI hospital-onset urinary tract infections (HOUTIs). METHODS: A retrospective observational study of patients from 43 acute-care hospitals was conducted. CAUTI cases were defined as those reported to the National Healthcare Safety Network. Non-CAUTI HOUTI was defined as a positive, non-contaminated, non-commensal culture collected on day 3 or later. All HOUTIs were required to have a new antimicrobial prescribed within 2 days of the first positive urine culture. Outcomes included secondary hospital-onset bacteremia and fungemia (HOB), total hospital costs, length of stay (LOS), readmission risk, and mortality. RESULTS: Of 549,433 admissions, 434 CAUTIs and 3,177 non-CAUTI HOUTIs were observed. The overall rate of HOB likely secondary to HOUTI was 3.7%. Total numbers of secondary HOB were higher in non-CAUTI HOUTIs compared to CAUTI (101 vs 34). HOB secondary to non-CAUTI HOUTI was more likely to originate outside the ICU compared to CAUTI (69.3% vs 44.1%). CAUTI was associated with adjusted incremental total hospital cost and LOS of $9,807 (P < .0001) and 3.01 days (P < .0001) while non-CAUTI HOUTI was associated with adjusted incremental total hospital cost and LOS of $6,874 (P < .0001) and 2.97 days (P < .0001). CONCLUSION: CAUTI and non-CAUTI HOUTI were associated with deleterious outcomes. Non-CAUTI HOUTI occurred more often and was associated with a higher facility aggregate volume of HOB than CAUTI. Patients at risk for UTIs in the hospital represent a vulnerable population who may benefit from surveillance and prevention efforts, particularly in the non-ICU setting.

Unplanned 120-Day ED Visits and Readmission Rates Following Common Stone Procedures.

OBJECTIVE: To quantify emergency department (ED) visits and hospital admissions (HA) after common urologic stone procedures including ureteroscopy (URS), shockwave lithotripsy (SWL), and percutaneous nephrolithotomy (PCL) which are a concern of payors, providers, and patients. MATERIALS AND METHODS: This is a retrospective cohort study using claims data from the IBM MarketScan Commercial and Medicare Supplement databases. Adults with a urologic stone diagnosis and no history of stone procedure in prior 12 months who underwent stone procedures between 2012 and 2017 were included. All-cause ED visits and HA were evaluated during 30, 60, 90, and 120-day periods following the index urologic stone procedure. RESULTS: A total of 166,287 patients were included in the analytic cohort. For inpatient-indexed procedures, cumulative ED visits rates following stone procedure at 120 days was 18.8% for URS, 19.2% for SWL, and 23.6% for PCL. A similar trend was observed with ED visit rates, following outpatient indexed procedures at 120 days with a cumulative rate of 14.2% of SWL patients, 14.9% of URS patients, and 17.3% of PCL. A similar trend was found when examining HA. ED and HA rates increased steadily through the 120-day time period. CONCLUSION: Rates of ED visits and HA following common stone procedures continue to rise at least up to 120 days following the index procedure whether in the outpatient or inpatient settings. While rates of unplanned care are similar for URS and SWL, patients undergoing PCL return to the hospital at higher rates.

Peripheral Nerve Stimulation in Chronic Knee Pain: A Case Series.

Introduction Chronic knee pain is increasing in prevalence and is associated with substantial limitations in functional mobility. Peripheral nerve stimulation (PNS) has been increasingly used to treat various chronic pain conditions. However, there is a paucity of research exploring the potential therapeutic benefit of PNS for chronic knee pain. Methods This research is a retrospective case series of all patients who received PNS for the treatment of chronic knee pain performed at a single-center academic medical institution between March 2021 and June 2022. The primary outcome was percent pain reduction six months after implantation. Outcome data was obtained via chart review and phone calls to patients. Secondary outcomes included percent pain reduction two weeks and two months after implantation and adverse medical events related to the procedure and nerve stimulation. Results Fourteen individual patients received PNS for chronic knee pain during the study period. Three of these patients received bilateral PNS for a total of 17 cases. The mean percent pain reduction six months after implantation was 52% (SD=28.2) (N=12). A total of 75.0% of participants (9/12) reported ≥50% reductions in pain six months after implantation. No adverse events were reported relating to the implantation procedure and/or nerve stimulation. Conclusion PNS is a safe and efficacious treatment modality for chronic knee pain with demonstrated long-term benefit. Further research should clarify patient factors associated with improved treatment response.

Scalable Non-Halogenated Co-solvent System for Large-Area, Four-Layer Slot-Die-Coated Organic Photovoltaics.

Sustainable processing solvents, photoactive materials, and scalable manufacturing will play a key role in commercializing printed organic photovoltaics (OPVs). The record-breaking pioneering OPV reports have done an outstanding job in accelerating the discovery of champion photoactive materials and device engineering practices; however, these works predominantly involve health-hazardous halogenated processing solvents/additives and non-scalable thin-film coating methods. Herein, large-area slot-die-manufactured OPV cells from eco-friendly halogen-free solvents and synthetically scalable materials are showcased. All the four layers; electron transport layer (SnO2), cathode interlayer (PDIN-H), bulk-heterojunction (BHJ, PTQ-10:BTP-4F-12), and hole transport layer [poly(3,4-ethylenedioxythiophene):polystyrene sulfonate) (PEDOT:PSS] are slot-die-coated in air. A non-halogenated co-solvent mixture of toluene and 2-methyl tetrahydrofuran is presented as an optimal processing solvent to realize the high-quality thin films of PTQ10:BTP-4F-12. The unencapsulated champion solar cells characterized in ambient conditions (RH = 30%, T = 22 °C) exhibit power conversion efficiencies (PCEs) of 12.1 and 17.8% under 1 Sun (100 mW/cm2) and indoor light-emitting diode lighting (580 µW/cm2) conditions, respectively. Additionally, PEDOT:PSS is successfully slot-die-coated atop BHJ by mitigating wettability challenges with the aid of surface treatment. The all four-layer slot-die-coated OPVs exhibit a PCE of 9.55%.

Improving Uptake of Emergency Department-initiated Buprenorphine: Barriers and Solutions.

Emergency departments (ED) are increasingly providing buprenorphine to persons with opioid use disorder. Buprenorphine programs in the ED have strong support from public health leaders and emergency medicine specialty societies and have proven to be clinically effective, cost effective, and feasible. Even so, few ED buprenorphine programs currently exist. Given this imbalance between evidence-based practice and current practice, proven behavior change approaches can be used to guide local efforts to expand ED buprenorphine capacity. In this paper, we use the theory of planned behavior to identify and address the 1) clinician factors, 2) institutional factors, and 3) external factors surrounding ED buprenorphine implementation. By doing so, we seek to provide actionable and pragmatic recommendations to increase ED buprenorphine availability across different practice settings.

Poly(ionic liquid) Gating Materials for High-Performance Organic Thin-Film Transistors: The Role of Block Copolymer Self-Assembly at the Semiconductor Interface.

The widespread realization of wearable electronics requires printable active materials capable of operating at low voltages. Polymerized ionic liquid (PIL) block copolymers exhibit a thickness-independent double-layer capacitance that makes them a promising gating medium for the development of organic thin-film transistors (OTFTs) with low operating voltages and high switching speed. PIL block copolymer structure and self-assembly can influence ion conductivity and the resulting OTFT performance. In an OTFT, self-assembly of the PIL gate on the semiconducting polymer may differ from bulk self-assembly, which would directly influence electrical double-layer formation. To this end, we used poly{[N,N'-bis(2-octyldodecyl)-naphthalene-1,4,5,8-bis(dicarboximide)-2,6-diyl]-alt-5,5'-(2,2'-bithiophene)} (P(NDI2OD-T2)) as a model semiconductor for our OTFTs, on which our PILs exhibited self-assembly. In this study, we explore this critical interface by grazing-incidence small-angle X-ray scattering (GISAXS) and atomic force microscopy (AFM) of P(NDI2OD-T2) and a series of poly(styrene)-b-poly(1-(4-vinylbenzyl)-3-butylimidazolium-random-poly(ethylene glycol) methyl ether methacrylate) (poly(S)-b-poly(VBBI+[X]-r-PEGMA)) block copolymers with varying PEGMA/VBBI+ ratios and three different mobile anions (where X = TFSI-, PF6-, or BF4-). We investigate the thin-film self-assembly of block copolymers as a function of device performance. Overall, a mixed orientation at the interface leads to improved device performance, while predominantly hexagonal packing leads to nonfunctional devices, regardless of the anion present. These PIL gated OTFTs were characterized with a threshold voltage below 1 V, making understanding of their structure-property relationships crucial to enabling the further development of high-performance gating materials.

High-Altitude Pulmonary Edema in Colorado Children: A Cross-Sectional Survey and Retrospective Review.

Kelly, Timothy D., Maxene Meier, Jason P. Weinman, Dunbar Ivy, John T. Brinton, and Deborah R. Liptzin. High-altitude pulmonary edema in Colorado children: a cross-sectional survey and retrospective review. High Alt Med Biol. 23:119-124, 2022. Introduction: Few studies of high-altitude pulmonary edema (HAPE) are specific to the pediatric population. The purpose of this investigation was to further characterize the radiographic patterns of pediatric HAPE, and to better understand ongoing risk following an initial pediatric HAPE episode. Methods: This study uses both a retrospective chart review and cross-sectional survey. Pediatric patients with HAPE at a single quaternary referral center in the Rocky Mountain Region were identified between the years 2013 and 2020. Patients were eligible if they presented with a clinical diagnosis of HAPE and had a viewable chest radiograph (CXR). Surveys were sent to eligible patients/families to gather additional information relating to family history, puberty, and HAPE recurrence. Results: Forty-two individuals met criteria for clinical diagnosis of HAPE with a viewable CXR. A majority of CXRs (24/42, 57.1%) demonstrated predominant right-sided involvement. Similarly, 24 CXRs (24/42, 57.1%) demonstrated predominant upper lobe involvement. Twenty-one (21/42, 50%) surveys were completed. A minority of individuals went on to experience at least one other HAPE episode (8/19, 42.1%). Conclusion: The most common radiographic pattern seen in pediatric HAPE is pulmonary edema that favors the right lung and upper lobes. After an initial HAPE presentation, some children will experience additional HAPE episodes.

Frequency and timing of emergency department visits and hospital admissions in stented patients following common stone procedures.

Emergency department (ED) visits and hospital admissions (HA) following urologic procedures are a concern for payors, providers, and patients. We seek to quantify ED visits and HA after urologic stone procedures. This is a retrospective cohort study using claims data from the IBM MarketScan Commercial and Medicare Supplement database. Adults with a urologic stone diagnosis and no history of stone procedure in prior 12 months who underwent stone procedures with ureteral stent codes between 2012 and 2017 were included. All-cause vs genitourinary (GU)-related ED visits and HA were evaluated during 30, 60, 90, and 120-day periods following the index urologic stone procedure. 88,047 patients were included in the analytic cohort. For inpatients, rate of all-cause vs GU-related ED visits was 10% vs 9% at 30 days and 19% vs 15% at 120 days. For outpatients, rate of all-cause vs GU-related ED visits was 9% vs 8% at 30 days and 15% vs 12% at 120 days. A similar trend was found when examining HA. Younger patients (18-44 years old) had higher rates of all-cause ED visits following inpatient index stone procedure (13% vs 10% at 30 days, p ≤ 0.0001). Twenty percent of patients have an ED visit or HA up to 120 days after having a stone procedure with most returning with GU-related complaint. Younger patients had the greatest burden among the study cohort. Further studies need to determine causation of these unplanned visits to guide appropriate intervention.

Thin-Film Engineering of Solution-Processable n-Type Silicon Phthalocyanines for Organic Thin-Film Transistors.

Metal and metalloid phthalocyanines are an abundant and established class of materials widely used in the dye and pigment industry as well as in commercial photoreceptors. Silicon phthalocyanines (SiPcs) are among the highest-performing n-type semiconductor materials in this family when used in organic thin-film transistors (OTFTs) as their performance and solid-state arrangement are often increased through axial substitution. Herein, we study eight axially substituted SiPcs and their integration into solution-processed n-type OTFTs. Electrical characterization of the OTFTs, combined with atomic force microscopy (AFM), determined that the length of the alkyl chain affects device performance and thin-film morphology. The effects of high-temperature annealing and spin coating time on film formation, two key processing steps for fabrication of OTFTs, were investigated by grazing-incidence wide-angle X-ray scattering (GIWAXS) and X-ray diffraction (XRD) to elucidate the relationship between thin-film microstructure and device performance. Thermal annealing was shown to change both film crystallinity and SiPc molecular orientation relative to the substrate surface. Spin time affected film crystallinity, morphology, and interplanar d-spacing, thus ultimately modifying device performance. Of the eight materials studied, bis(tri-n-butylsilyl oxide) SiPc exhibited the greatest electron field-effect mobility (0.028 cm2 V-1 s-1, a threshold voltage of 17.6 V) of all reported solution-processed SiPc derivatives.

'Gun shop projects' for suicide prevention in the USA: current state and future directions.

OBJECTIVES: To describe community-driven suicide prevention partnerships between firearm retailers and public health officials ('gun shop projects'), including common elements and challenges. METHODS: We conducted qualitative interviews with leaders from state-level and national-level partnerships to determine common features, challenges and strategies used by these groups. Data were coded via theme analysis; two independent coders followed a shared codebook developed in an iterative fashion and with high inter-rater reliability. RESULTS: Across 10 interviews, data revealed four main themes: (1) community building was a cornerstone of these efforts; (2) appropriate messaging and language were vital to successes; (3) groups employed various educational and outreach campaigns and (4) groups identified common challenges and obstacles. CONCLUSIONS: Gun shop project partnerships between firearm retailers and public health officials show promise, with thematic data demonstrating common trends and steps towards successful programme implementation. Evaluative data are needed to determine the impact of these efforts on suicide prevention in local communities.

Physician attitudes on buprenorphine induction in the emergency department: results from a multistate survey.

STUDY OBJECTIVE: Emergency Departments (ED) are rapidly becoming an important location for initiation of buprenorphine (EDBUP) for the treatment of opioid use disorder (OUD). Previous investigations of emergency medicine physicians' perceived barriers and attitudes toward EDBUP exclusively sampled from urban, academic-affiliated physicians. We administered a multistate survey to an institutionally and geographically diverse collection of emergency medicine physicians to better understand the professional opinions of EDBUP implementation across a variety of practice settings. METHODS: This cross-sectional survey study used an online survey instrument to convenience sample emergency medicine physicians. In order to sample from various practice environments, participants were identified from (1) statewide ACEP chapters and (2) Facebook groups exclusive to emergency medicine physicians. The survey explored physicians' attitudes of EDBUP adoption and the perceived barriers to doing so. RESULTS: 162 emergency medicine physicians completed the survey. 76% of respondents agreed that emergency medicine physicians should offer EDBUP in the treatment of OUD. When stratified by practice setting and X-waiver status, 96% of X-waivered physicians, 73% of academic physicians, 49% of non-academic physicians, and 34% of non-X-waivered physicians felt comfortable initiating EDBUP. Lack of access to outpatient MOUD referral was the most frequently cited barrier to EDBUP across all practice settings. CONCLUSIONS: An institutionally and geographically diverse group of emergency medicine physicians endorsed substantial support for EDBUP. Emergency medicine physicians practicing in different clinical environments endorsed similar barriers to EDBUP implementation.

Regioisomerically Pure 1,7-Dicyanoperylene Diimide Dimer for Charge Extraction from Donors with High Electron Affinities.

Perylene diimide (PDI) has attracted widespread interest as an inexpensive electron acceptor for photovoltaic applications; however, overcrystallization in the bulk heterojunction typically leads to low device performance. Recent work has addressed this issue by forming bay-linked PDI dimers and oligomers, where the steric bulk of adjacent PDI units forces the molecule to adopt a nonplanar structure. This disrupts the molecular packing and limits domain sizes in the bulk heterojunction. Unfortunately, the introduction of electron-donating/-withdrawing groups in the bay region is also the best way to fine-tune the frontier molecular orbitals (FMOs) of PDI, which is highly desirable from a device optimization standpoint. This competition for the bay region has made it difficult for PDI to keep pace with other non-fullerene acceptors. Here, we report the synthesis of regioisomerically pure 1,7-dicyanoperylene diimide and its dimerization through an imide linkage. We show that this is an effective strategy to tune the energies of the FMOs while simultaneously suppressing overcrystallization in the bulk heterojunction. The resulting acceptor has a low LUMO energy of -4.2 eV and is capable of accepting photogenerated electrons from donor polymers with high electron affinities, even when conventional acceptors such as PDI, PC71BM, and ITIC cannot.

Watching Paint Dry: Operando Solvent Vapor Annealing of Organic Solar Cells.

The commercialization of organic solar cell (OSC) technology will require highly reproducible techniques for controlling the morphology of bulk heterojunction blends. Variable-pressure solvent vapor annealing (VP-SVA) is one method for postprocessing organic solar cells with high precision; it can prevent the overannealing of cells that plagues conventional SVA processes. To gain insight into the dynamics of the VP-SVA process, we carried out operando measurements on OSCs with correlated in situ grazing-incidence wide-angle X-ray scattering (GIWAXS) measurements. We show that the partial pressure of solvent vapor controls the length scale of film reordering, with optimal restructuring taking place below the saturation vapor pressure of the solvent. The experiments reveal how the film crystallinity, domain sizes, and percolation pathways evolve over the course of the VP-SVA process and how subtle differences in these morphological parameters differentiate good OSCs from champion cells.