Avoiding the Center-Symmetry Trap: Programmed Assembly of Dipolar Precursors into Porous, Crystalline Molecular Thin Films.

Liquid-phase, quasi-epitaxial growth is used to stack asymmetric, dipolar organic compounds on inorganic substrates, permitting porous, crystalline molecular materials that lack inversion symmetry. This allows material fabrication with built-in electric fields. A new programmed assembly strategy based on metal-organic frameworks (MOFs) is described that facilitates crystalline, noncentrosymmetric space groups for achiral compounds. Electric fields are integrated into crystalline, porous thin films with an orientation normal to the substrate. Changes in electrostatic potential are detected via core-level shifts of marker atoms on the MOF thin films and agree with theoretical results. The integration of built-in electric fields into organic, crystalline, and porous materials creates possibilities for band structure engineering to control the alignment of electronic levels in organic molecules. Built-in electric fields may also be used to tune the transfer of charges from donors loaded via programmed assembly into MOF pores. Applications include organic electronics, photonics, and nonlinear optics, since the absence of inversion symmetry results in a clear second-harmonic generation signal.

Comparison of Interventions Made in an Ambulatory Pharmacist-Managed Refill Model to Usual Physician Care.

Background: With the current practice model, there is less time for physicians to address refill authorization requests (RARs) while performing consistent quality care, which creates an opportunity for pharmacists to assist in refills. Currently, inadequate evidence is available to support this intervention. Objective: To compare the rate of medication management interventions (MMIs - drug therapy changes, laboratory monitoring ordered, or office visit scheduled) initiated by the pharmacist-managed authorization center (PMAC) to usual care. Methods: A retrospective, noninferiority study looked at 4000 RARs from 6 primary care centers from January 2016 through March 2017. The primary endpoint compared the rate of MMIs between PMAC and usual care. Noninferiority was concluded if the upper limit of the 95% CI of the difference in interventions was <2%. Secondary endpoints included total, type, and acceptance rate of PMAC recommendations. Results: A total of 3830 patients were included, with 4732 medications requested (2183 reviewed by PMAC and 2549 by usual care). MMIs occurred in 153 medications within PMAC (7.0%) versus 90 for usual care (3.5%). The difference in total MMIs between PMAC and usual care was -3.5% (95% confidence interval = -4.8% to -2.2%). Medications reviewed by PMAC had significantly higher number of laboratory monitoring (P = .036) and scheduled appointments (P < .001). There were 294 PMAC recommendations (13.5%) with a 52.0% acceptance rate. Conclusion and Relevance: This study showed that PMAC was superior to usual care for reviewing RARs. There was a statistically significant improvement in medication monitoring and patient follow-up, supporting the idea of including a pharmacist in the decision making.