Ligand-Directed Self-Assembly of Organic-Semiconductor/Quantum-Dot Blend Films Enables Efficient Triplet Exciton-Photon Conversion

Blends comprising organic semiconductors and inorganic quantum dots (QDs) are relevant for many optoelectronic applications and devices. However, the individual components in organic-QD blends have a strong tendency to aggregate and phase-separate during film processing, compromising both their structural and electronic properties. Here, we demonstrate a QD surface engineering approach using electronically active, highly soluble semiconductor ligands that are matched to the organic semiconductor host material to achieve well-dispersed inorganic-organic blend films, as characterized by X-ray and neutron scattering, and electron microscopies. This approach preserves the electronic properties of the organic and QD phases and also creates an optimized interface between them. We exemplify this in two emerging applications, singlet-fission-based photon multiplication (SF-PM) and triplet-triplet annihilation-based photon upconversion (TTA-UC). Steady-state and time-resolved optical spectroscopy shows that triplet excitons can be transferred with near unity efficiently across the organic-inorganic interface, while the organic films maintain efficient SF (190% yield) in the organic phase. By changing the relative energy between organic and inorganic components, yellow upconverted emission is observed upon 790 nm NIR excitation. Overall, we provide a highly versatile approach to overcome longstanding challenges in the blending of organic semiconductors with QDs that have relevance for many optical and optoelectronic applications.

Re-Thinking Dimer Design Principles with Indolonaphthyridine Intramolecular Singlet Fission

Singlet fission is a phenomenon that could significantly improve the efficiency of photovoltaic devices. Indolonaphthyridine thiophene (INDT) is a photostable singlet fission material that could potentially be utilised in singlet fission-based photovoltaic devices. This study investigates the intramolecular singlet fission (i-SF) mechanism of INDT dimers linked via para-phenyl, meta-phenyl and fluorene bridging groups. Using ultra-fast spectroscopy the highest rate of singlet fission is found in the para-phenyl linked dimer. Quantum calculations show the para-phenyl linker encourages enhanced monomer electronic coupling. Increased rates of singlet fission were also observed in the higher polarity o-dichlorobenzene, relative to toluene, indicating that charge-transfer states have a role in mediating the process. The mechanistic picture of polarisable singlet fission materials, such as INDT, extends beyond the traditional mechanistic landscape.

Aza-Cibalackrot: Turning on Singlet Fission Through Crystal Engineering

Singlet fission is a photophysical process that provides a pathway for more efficient harvesting of solar energy in photovoltaic devices. The design of singlet fission candidates is non-trivial and requires careful optimization of two key criteria: (1) correct energetic alignment and (2) appropriate intermolecular coupling. Meanwhile, this optimization must not come at the cost of molecular stability or feasibility for device applications. Cibalackrot is a historic and stable organic dye which, although it has been suggested to have ideal energetics, does not undergo singlet fission due to large interchromophore distances, as suggested by single crystal analysis. Thus, while the energetic alignment is satisfactory, the molecule does not have the desired intermolecular coupling. Herein, we improve this characteristic through molecular engineering with the first synthesis of an aza-cibalackrot and show, using ultrafast transient spectroscopy, that singlet fission is successfully "turned on."

Nanocurcumin combined with insulin alleviates diabetic kidney disease through P38/P53 signaling axis

Treatments for diabetic kidney disease (DKD) mainly focus on managing hyperglycemia and hypertension, but emerging evidence suggests that inflammation also plays a role in the pathogenesis of DKD. This 10-week study evaluated the efficacy of daily oral nanoparticulate-curcumin (nCUR) together with long-acting insulin (INS) to treat DKD in a rodent model. Diabetic rats were dosed with unformulated CUR alone, nCUR alone or together with INS, or INS alone. The progression of diabetes was reflected by increases in plasma fructosamine, blood urea nitrogen, creatinine, bilirubin, ALP, and decrease in albumin and globulins. These aberrancies were remedied by nCUR+INS or INS but not by CUR or nCUR. Kidney histopathological results revealed additional abnormalities characteristic of DKD, such as basement membrane thickening, tubular atrophy, and podocyte cytoskeletal impairment. nCUR and nCUR+INS mitigated these lesions, while CUR and INS alone were far less effective, if not ineffective. To elucidate how our treatments modulated inflammatory signaling in the liver and kidney, we identified hyperactivation of P38 (MAPK) and P53 with INS and CUR, whereas nCUR and nCUR+INS deactivated both targets. Similarly, the latter interventions led to significant downregulation of renal NLRP3, IL-1β, NF-ĸB, Casp3, and MAPK8 mRNA, indicating a normalization of inflammasome and apoptotic pathways. Thus, we show therapies that reduce both hyperglycemia and inflammation may offer better management of diabetes and its complications.

Quantitative Singlet Fission in Solution-Processable Dithienohexatrienes

Singlet fission (SF) is a promising strategy to overcome thermalization losses and enhance the efficiency of single junction photovoltaics (PVs). The development of this field has been strongly material-limited, with a paucity of materials able to undergo SF. Rarer still are examples that can produce excitons of sufficient energy to be coupled to silicon PVs (>1.1 eV). Herein, we examine a series of a short-chain polyene, dithienohexatriene (DTH), with tailored material properties and triplet (T1) energy levels greater than 1.1 eV. We find that these highly soluble materials can be easily spin-cast to create thin films of high crystallinity that exhibit ultrafast singlet fission with near perfect triplet yields of up to 192%. We believe that these materials are the first solution-processable singlet fission materials with quantitative triplet formation and energy levels appropriate for use in conjunction with silicon PVs.

Oral Nanocurcumin Alone or in Combination with Insulin Alleviates STZ-Induced Diabetic Neuropathy in Rats

Diabetes mellitus (DM), a multifaceted metabolic disorder if not managed properly leads to secondary complications. Diabetic peripheral neuropathy (DPN) is one such complication caused by nerve damage that cannot be reversed but can be delayed. Recently, diabetes patients are using dietary supplements, although there remains a general skepticism about this practice. Curcumin (CUR), one such supplement can help prevent underlying low-grade inflammation in diabetes, but it is plagued by poor oral bioavailability. To better understand the role of bioavailability in clinical outcomes, we have tested double-headed nanosystems containing curcumin (nCUR) on DPN. Because CUR does not influence glucose levels, we have also tested the effects of nCUR combined with long-acting subcutaneous insulin (INS). nCUR with or without INS alleviates DPN at two times lower dose than unformulated CUR, as indicated by qualitative and quantitative analysis of the hind paw, sciatic nerve, spleen, and L4-6 spinal cord. In addition, nCUR and nCUR+INS preserve hind paw nerve axons as evident by the Bielschowsky silver stain and intraepidermal nerve fibers (IENF) density measured by immunofluorescence. The mechanistic studies further corroborated the results, where nCUR or nCUR+INS showed a significant decrease in TUNEL positive cells, mRNA expression of NLRP3, IL-1β, and macrophage infiltration while preserving nestin and NF200 expression in the sciatic nerve. Together, the data confirms that CUR bioavailability is proportional to clinical outcomes and INS alone may not be one of the solutions for DM. This study highlights the potential of nCUR with or without INS in alleviating DPN and warrants further investigation.

Differential Performance and Lung Deposition of Levofloxacin with Different Nebulisers Used in Cystic Fibrosis

We compared the performance and levofloxacin (Quinsair) lung deposition of three nebulisers commonly used in CF (I-Neb Advance, eFlow rapid, and LC Plus) with the approved nebuliser Zirela. The delivered dose, delivery rate, and aerosol particle size distribution (APSD) for each device were determined using the methods described in the Pharmacopeia. High-resolution computed tomography scans obtained from seven adult patients with mild CF were used to generate computer-aided, three-dimensional models of their airway tree to assess lung deposition using functional respiratory imaging (FRI). The eFlow rapid and the LC Plus showed poor delivery efficiencies due to their high residual volumes. The I-Neb, which only delivers aerosols during the inspiratory phase, achieved the highest aerosol delivery efficiency. However, the I-Neb showed the largest particle size and lowest delivery rate (2.9 mg/min), which were respectively associated with a high extrathoracic deposition and extremely long nebulisation times (>20 min). Zirela showed the best performance considering delivery efficiency (159.6 mg out of a nominal dose of 240 mg), delivery rate (43.5 mg/min), and lung deposition (20% of the nominal dose), requiring less than 5 min to deliver a full dose of levofloxacin. The present study supports the use of drug-specific nebulisers and discourages the off-label use of general-purpose devices with the present levofloxacin formulation since subtherapeutic lung doses and long nebulisation times may compromise treatment efficacy and adherence.

Climate change and non-migration - exploring the role of place relations in rural and coastal Bangladesh

Of growing research and policy interest are the experiences of people living under conditions of climate change-induced environmental stress, which either are unable to migrate (sometimes described as a 'trapped population') or are seemingly unwilling to do so (sometimes described as the 'voluntarily immobile'). This paper problematises and expands upon these binary categories: examining the complex dimensionality of non-migration as a form of place relations, explored through qualitative study of rural and coastal Bangladeshi communities. Through 60 semi-structured interviews of individuals from four communities in the Kalapara region, the analysis proffers four qualitatively derived and inter-related dimensions of voluntary and involuntary non-migration framed as a form of place relations. These four dimensions concern the following: (1) livelihood opportunities, (2) place obduracy, (3) risk perceptions, and (4) social-structural constraints, with the interplay between these elements explaining diverse non-migratory experiences. In our analysis, 'place obduracy' is introduced as a concept to describe the differential speed of environmental change and socio-cultural adaptation responses to explain non-migratory experiences. Our discussion provides insight into how to best support non-migrant people's adaptive capacity in the face of growing climate emergency.

Femtosecond Transient Absorption Microscopy of Singlet Exciton Motion in Side-Chain Engineered Perylene-Diimide Thin Films

We present a statistical analysis of femtosecond transient absorption microscopy applied to four different organic semiconductor thin films based on perylene-diimide (PDI). By achieving a temporal resolution of 12 fs with simultaneous sub-10 nm spatial precision, we directly probe the underlying exciton transport characteristics within 3 ps after photoexcitation free of model assumptions. Our study reveals sub-picosecond coherent exciton transport (12-45 cm2 s-1) followed by a diffusive phase of exciton transport (3-17 cm2 s-1). A comparison between the different films suggests that the exciton transport in the studied materials is intricately linked to their nanoscale morphology, with PDI films that form large crystalline domains exhibiting the largest diffusion coefficients and transport lengths. Our study demonstrates the advantages of directly studying ultrafast transport properties at the nanometer length scale and highlights the need to examine nanoscale morphology when investigating exciton transport in organic as well as inorganic semiconductors.

Singlet exciton fission via an intermolecular charge transfer state in coevaporated pentacene-perfluoropentacene thin films

Singlet exciton fission is a spin-allowed process in organic semiconductors by which one absorbed photon generates two triplet excitons. Theory predicts that singlet fission is mediated by intermolecular charge-transfer states in solid-state materials with appropriate singlet-triplet energy spacing, but direct evidence for the involvement of such states in the process has not been provided yet. Here, we report on the observation of subpicosecond singlet fission in mixed films of pentacene and perfluoropentacene. By combining transient spectroscopy measurements to nonadiabatic quantum-dynamics simulations, we show that direct excitation in the charge-transfer absorption band of the mixed films leads to the formation of triplet excitons, unambiguously proving that they act as intermediate states in the fission process.

Triple-Cation-Based Perovskite Photocathodes with AZO Protective Layer for Hydrogen Production Applications

Metal halide perovskites are actively pursued as photoelectrodes to drive solar fuel synthesis. However, currently, these photocathodes suffer from limited stability in water, which hampers their practical application. Here, we report a high-performance solution-processable photocathode composed of cesium formamidinium methylammonium triple-cation lead halide perovskite protected by an Al-doped ZnO (AZO) layer combined with a Field's metal encapsulation. Careful selection of charge transport layers resulted in an improvement in photocurrent, fill factor, device stability and reproducibility. The dead pixels count reduced from 25 to 6% for the devices with an AZO layer, and in photocathodes with an AZO layer the photocurrent density increased by almost 20% to 14.3 mA cm^-2. In addition, we observed a 5-fold increase in the device lifetime for photocathodes with AZO, which reached up to 18 h before complete failure. Finally, the photocathodes are fabricated using low-cost and scalable methods, which have promise to become compatible with standard solution-based processes.

Systematic Review of Community Paramedicine and EMS Mobile Integrated Health Care Interventions in the United States

Emergency medical services (EMS) in the United States are frequently used for nonurgent medical needs. Use of 911 and the emergency department (ED) for primary care-treatable conditions is expensive, inefficient, and undesirable for patients and providers. The objective is to describe the outcomes from community paramedicine (CP) and mobile integrated health care (MIH) interventions related to the Quadruple Aim. Three electronic databases were searched for peer-review literature on CP-MIH interventions in the United States. Eight articles reporting data from 7 interventions were included. Four studies reported high levels of patient satisfaction, and only 3 measured health outcomes. No study reported provider satisfaction measures. Reducing ED and inpatient utilization were the most common study outcomes, and programs generally were successful at reducing utilization. With reduced utilization, costs should be reduced; however, most studies did not quantify savings. Future studies should conduct economic analyses that not only compare the intervention to traditional EMS services, but also measure potential cost savings to the EMS agencies running the intervention. Most cost savings from reduced utilization will be to insurance companies and patients, but more efficient use of EMS agencies' resources could lead to cost savings that could offset intervention implementation costs. The other 3 aims (health, patient satisfaction, and provider satisfaction) were reported inconsistently in these studies and need to be addressed further. Given the small number of heterogeneous studies reviewed, the potential for CP-MIH interventions to comprehensively address the Quadruple Aim is still unclear, and more research on these programs is needed.

To branch or not to branch: C–H selectivity of thiophene-based donor–acceptor–donor monomers in direct arylation polycondensation exemplified by PCDTBT

The possibility for unselective C–H activation of a thiophene-based, donor–acceptor–donor monomer during direct arylation polycondensation is investigated.

Air-Stable n-channel Diketopyrrolopyrrole-Diketopyrrolopyrrole Oligomers for High Performance Ambipolar Organic Transistors

n-channel organic semiconductors are prone to oxidation upon exposed to ambient conditions. Herein, we report design and synthesis of diketopyrrolopyrrole (DPP)-based oligomers for ambipolar organic thin-film transistors (OFETs) with excellent air and bias stability at ambient conditions. The cyclic voltammetry measurements reveal exceptional electrochemical stability during the redox cycle of oligomers. Structural properties including aggregation, crystallinity, and morphology in thin film were investigated by UV-visible spectroscopy, atomic force microscopy (AFM), thin-film X-ray diffraction (XRD), and grazing incidence small-angle X-ray scattering (GISAXS) measurements. AFM reveals morphological changes induced by different processing conditions whereas GISAXS measurements show an increase in the population of face-on oriented crystallites in films subjected to a combination of solvent and thermal treatments. These measurements also highlight the significance of chalcogen atom from sulfur to selenium on the photophysical, optical, electronic, and solid-state properties of DPP-DPP oligomers. Charge carrier mobilities of the oligomers were investigated by fabricating top-gate bottom-contact (TG-BC) thin-film transistors by annealing the thin films under various conditions. Combined solvent and thermal annealing of DPP-DPP oligomer thin films results in consistent electron mobilities as high as ∼0.2 cm(2) V(-1) s(-1) with an on/off ratio exceeding 10(4). Field-effect behavior was retained for up to ∼4 weeks, which illustrates remarkable air and bias stability. This work paves the way toward the development of n-channel DPP-DPP-based oligomers exhibiting retention of field-effect behavior with superior stability at ambient conditions.

Anisotropic optical properties in electroluminescent conjugated polymers based on grazing angle photoluminescence measurements

Grazing angle photoluminescence (GPL) originates from a waveguided light emitted at grazing angle to the substrate due to the total internal reflections, and the light emission is polarized with enhanced intensity at selective mode wavelength. GPL measurements reveal the optical anisotropy of luminescent conjugated polymers, in particular, the alignment of emitting dipoles from which emission occurs, in contrast to spectroscopic ellipsometry measurements that give the anisotropy in the absorption. Based on the GPL emission intensities and spectra, we investigate the anisotropic optical properties in electroluminescent poly(9,9'-di-n-octylfluorene-alt-benzothiadiazole) (F8BT) conjugated polymer thin films of different molecular weights (M(n) = 9-255 kg/mol), both in the pristine and annealed states. The optical anisotropy in F8BT films generally increases with molecular weight, suggesting that higher molecular weight polymers with longer chains are more likely to lie in-plane to the substrate. Upon annealing, high molecular weight F8BT films show even a higher degree of anisotropy, in contrast to low molecular weight F8BT films that become more isotropic. Annealing causes the polymer chains to rearrange and adopt a configuration in which the interchain exciton migration to better ordered low energy (LE) emissive states is strongly suppressed. We observe that the emissive states in F8BT are strongly affected by the local polymer chain arrangement, producing the less ordered high energy (HE) emissive states near the substrate interface where there is a higher degree of chain disorder and the LE states in the bulk of the film. When spin coated onto a quartz substrate precoated with a poly(styrenesulfonate)-doped poly(3,4-ethylenedioxythiophene) (PEDOT:PSS) layer, films of F8BT show severe luminescence quenching near the PEDOT:PSS interface for both the LE and HE emissive states, but a selective quenching of the LE states in the bulk of the film. These observations have important implications for fabricating efficient electronic devices using conjugated polymers as an active material, since the performance of these devices will strongly depend on anisotropic optical properties of electroluminescent conjugated polymers.

Distress and disease status among patients with rheumatoid arthritis: roles of coping styles and perceived responses from support providers

Previous research has shown that social support can have a beneficial impact on coping processes and psychological adjustment in patients with rheumatoid arthritis (RA). The association of individual coping styles and perceived responses from others to one's pain episodes with patients 'distress and disease status over time was investigated. The sample consisted of 42 middle-aged patients with RA who were predominantly White (98%), female (64%), and married (88%). Participants completed surveys and their rheumatologist completed clinical assessments of patient disease status at 2 time points over a 9-month period. Although punishing responses from others (e.g., getting irritated or angry when the patient is in pain) were perceived as relatively infrequent, they were associated with a patient coping style of focusing on and venting of negative emotion as well as elevated negative affect (NA). Findings also indicated that those who perceived punishing responses from close others and coped by venting negative emotions reported increased NA over time and were rated by their rheumatologist as having more severe RA disease status over time. Implications for psychosocial intervention and directions for future research are discussed.

Improving adjustment to chronic illness through strategic self-presentation: an experimental study on a renal dialysis unit

Laboratory studies show that strategic self-presentations strongly influence private self-evaluations. The present study experimentally manipulated self-presentations of dialysis patients' coping skills in order to influence their adjustment. In all, 42 renal dialysis patients matched for diabetes, gender, and dialysis years were randomly assigned to 3 conditions; adjustment was assessed at baseline, post-intervention, and 1 month follow-up. Patients in a self-presentation condition selectively presented themselves as successful copers in a videotaped interview, ostensibly as part of a training program for new patients. Patients in a problem disclosure condition discussed problems with managing their illness. Control group patients viewed a medical videotape about adjusting to dialysis. Patients in the self-presentation condition reported better adjustment, fewer physical symptoms, and more coping skills 1 month later, compared with patients in the other 2 conditions. In addition, coping skills were shown to mediate the relationship between strategic self-presentation and adjustment.

Improving adjustment to chronic illness through strategic self-presentation: an experimental study on a renal dialysis unit

Laboratory studies show that strategic self-presentations strongly influence private self-evaluations. The present study experimentally manipulated self-presentations of dialysis patients' coping skills in order to influence their adjustment. In all, 42 renal dialysis patients matched for diabetes, gender, and dialysis years were randomly assigned to 3 conditions; adjustment was assessed at baseline, post-intervention, and 1 month follow-up. Patients in a self-presentation condition selectively presented themselves as successful copers in a videotaped interview, ostensibly as part of a training program for new patients. Patients in a problem disclosure condition discussed problems with managing their illness. Control group patients viewed a medical videotape about adjusting to dialysis. Patients in the self-presentation condition reported better adjustment, fewer physical symptoms, and more coping skills 1 month later, compared with patients in the other 2 conditions. In addition, coping skills were shown to mediate the relationship between strategic self-presentation and adjustment.

A comparison of attributions, health beliefs, and negative emotions as predictors of fluid adherence in renal dialysis patients: a prospective analysis

Excessive fluid intake in hemodialysis patients can lead to serious cardiovascular complications. However, previous studies have not investigated factors that affect fluid adherence over time. The influence of three sets of factors--attributions, health beliefs, and negative emotions--was examined to determine their influence on changes in fluid adherence over time. We assessed patient's fluid-intake changes across two time periods, as well as their absolute level. The results indicated that attributions, while predicting absolute fluid adherence, did not predict changes in fluid adherence. On the other hand, health beliefs predicted changes in fluid adherence but not absolute levels. Negative emotions predicted neither absolute nor changes in fluid adherence. It is suggested that attributions are more responsible for maintenance and control of stable fluid adherence levels, while health beliefs are more responsible for motivational factors related to changes in fluid adherence over time.

Serum albumin and depression in end-stage renal disease

The purpose of our study was to determine whether albumin influenced patients' depression or whether depression influenced patients' albumin. Patients from a tertiary care university medical hospital were assessed for both serum albumin and depression [Beck Depression Inventory (BDI)] at two time points separated by 6 months. Data were collected for 72 patients (43 male, 29 female; mean age 54 years). The sample consisted of 32 hemodialysis and 40 peritoneal dialysis patients. The outcome measures were changes in depression and albumin over time. Regression analysis indicated that all three Time 1 measures of BDI, BDICOG (BDI cognitive), and BDISOM (BDI somatic) significantly predicted decreases in albumin from Time 1 to Time 2 (beta = -0.22, p < 0.002; beta = -0.17, p < 0.015; beta = -0.23, p < 0.002, respectively). However, Time 1 measures of albumin did not predict changes in BDI, BDICOG, or BDISOM (beta = -0.04, p < 0.738; beta = -0.08, p < 0.375; beta = -0.07, p < 0.618, respectively). Thus depression at Time 1 predicted decreases in albumin from Time 1 to Time 2. The reverse effect that albumin influences depression from Time 1 to Time 2 was not found. In conclusion, this study suggests that depression influences the nutritional status indicated by albumin levels. Thus poor nutritional status may mediate the relation between depression and mortality in end-stage renal disease (ESRD).

Interpersonal expectations, social support, and adjustment to chronic illness

Chronic illness places considerable burdens on patients and their interpersonal relations with families. In this study, patients' perceptions of family and medical staff expectations regarding responsibility for care and routine functions were examined. The authors hypothesized that a patient's perceived inability to meet others' expectations about coping with illness would lead to poorer adjustment. Forty-two chronically ill patients were assessed prospectively for perceptions of others' expectations, social support, and psychological adjustment. Findings confirmed that expectations predicted subsequent decreases in psychological adjustment over a 3-month period, even when social support was controlled. A test of the reverse hypothesis showed that poorly adjusted patients did not misperceive others' expectations. Theoretical interpretations of the findings and their relation to social support research are discussed.

Interpersonal expectations, social support, and adjustment to chronic illness

Chronic illness places considerable burdens on patients and their interpersonal relations with families. In this study, patients' perceptions of family and medical staff expectations regarding responsibility for care and routine functions were examined. The authors hypothesized that a patient's perceived inability to meet others' expectations about coping with illness would lead to poorer adjustment. Forty-two chronically ill patients were assessed prospectively for perceptions of others' expectations, social support, and psychological adjustment. Findings confirmed that expectations predicted subsequent decreases in psychological adjustment over a 3-month period, even when social support was controlled. A test of the reverse hypothesis showed that poorly adjusted patients did not misperceive others' expectations. Theoretical interpretations of the findings and their relation to social support research are discussed.

Weight reduction and fluid intake in an obese and fluid noncompliant ESRD patient

This case study describes the application of a behavioral weight reduction program to an obese ESRD patient who was also fluid noncompliant. The major purpose of the study was to determine whether the behavioral weight reduction program could be successfully applied to a hemodialysis patient, and if so, what effect reduced caloric intake would have on fluid intake. Based on animal and human studies showing a strong relation between eating and drinking, it was expected that body weight reduction would be accompanied by reduced fluid intake. On the other hand, an alternative psychological hypothesis suggested that increased fluid intake might be substituted for reduced food intake. The results of the weight reduction program indicated that a successful weight reduction of 42 lbs was maintained over an 18-month follow-up period. However, fluid intake increased during periods when caloric intake was reduced. Overall, the results indicated that behavioral weight reduction programs can be successfully applied to weight reduction in obese hemodialysis patients but that ways to avoid increased fluid intake need to be carefully addressed by such programs.

Accuracy or bias in nurses' ratings of patient compliance: a comparison of treatment modality

OBJECTIVE

The study examined the accuracy of nurses' assessments of patient compliance and identified factors influencing these assessments, including possible biases.

DESIGN

Nurses' assessments of compliance, lab serum levels of dietary compliance, and interdialytic weight gain (IWG) were collected and compared to each other. End-stage renal disease (ESRD) patients on peritoneal dialysis (PD) and hemodialysis (HD) were compared on these measures and their compliance.

SETTING

The study was conducted at the tertiary care university hospital at Stony Brook.

PATIENTS

Data were collected for 62 ESRD patients (38 male, 24 female; mean age 54 years). The sample consisted of 26 HD and 36 PD patients.

INTERVENTIONS

Nurses rated patients' compliance with fluid restrictions (HD patients only) and overall dietary compliance, as well as individual indicators of compliance including protein, potassium, and phosphorus compliance on a 7-point rating scale. Interdialytic weight gain, dietary (serum BUN and K levels), and medication compliance were recorded from charts for a 3-month period for each patient.

MAIN OUTCOME MEASURES

The main outcome measures were the correlations between nurses' ratings of compliance and medical compliance data and the regression coefficients, which indicate the relative importance of each of the factors that nurses use to make their compliance ratings.

RESULTS

Nurses' ratings for patients in both treatment modalities were highly correlated with the medical data for measures of fluid (r = 0.66, p < 0.001), potassium (r = 0.36, p < 0.01), and phosphorus (r = 0.36, p < 0.01). A regression analysis indicates that potassium (beta = 0.48, p < 0.001), phosphorus (beta = 0.19, p < 0.05), and protein (beta = 0.31, p < 0.01) all significantly contributed to nurses' assessments of patients' overall compliance. However, nurses' ratings of education levels for patients in both treatment modalities were not associated with phosphorus (r = 0.07, p < 0.61), protein (r = 0.18, p < 0.23), or potassium (r = 0.03, p < 0.85) measures. Finally, regressions revealed that nurses used personal knowledge of the patients when rating noncompliant patients (beta = 0.49, p < 0.05) but not when rating compliant patients (beta = 0.05, p < 0.75).

CONCLUSIONS

Nurses rely heavily on medical records to rate patients' compliance and to make accurate assessments. Nurses also use several individual indicators (lab values and IWG) to rate overall dietary compliance, suggesting a thorough assessment. While assessments are not biased by personal factors such as nurses' perceptions of patients' education levels, nurses do rely on personal knowledge when rating noncompliant patients.

Burden of self-care in seriously ill patients: impact on adjustment

Perceived, but not actual, control over the treatment has been consistently related to better adjustment in chronic illness. This study examined the relationship between actual control over treatment and severity of illness and their influence on depression in a chronically ill population of end-stage renal disease (ESRD) patients. The authors hypothesized that as severity of illness increases, the burden of control over treatment would increase depression. Severity of illness and depression were assessed for 98 ESRD patients. Control over treatment was represented by whether dialysis patients were self-administering treatment (high control) or were receiving treatment from the medical staff (low control). Results indicated that for the most severely ill patients, high control over treatment resulted in poorer adjustment. Furthermore, this effect was due in part to how illness interferes with social relationships in seriously ill, self-care patients.

Burden of self-care in seriously ill patients: impact on adjustment

Perceived, but not actual, control over the treatment has been consistently related to better adjustment in chronic illness. This study examined the relationship between actual control over treatment and severity of illness and their influence on depression in a chronically ill population of end-stage renal disease (ESRD) patients. The authors hypothesized that as severity of illness increases, the burden of control over treatment would increase depression. Severity of illness and depression were assessed for 98 ESRD patients. Control over treatment was represented by whether dialysis patients were self-administering treatment (high control) or were receiving treatment from the medical staff (low control). Results indicated that for the most severely ill patients, high control over treatment resulted in poorer adjustment. Furthermore, this effect was due in part to how illness interferes with social relationships in seriously ill, self-care patients.

Measuring disease severity in patients with end-stage renal disease: validity of the Craven et al. ESRD Severity Index

The validity of a recently developed measure of disease severity, the End-stage Renal Disease Severity Index (Craven et al. 1991) was examined in haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients (total N = 82). Scores on the ESRD Severity Index were compared with three commonly identified components of disease severity: physiological indices of severity, functional status, and psychological burden of illness. For the entire group of subjects, scores on the ESRD Severity Index were negatively associated with functional ability and positively related to physiological severity. ESRD Severity Index scores showed a weaker relationship with psychological burden of illness which depended in part on treatment mode. Disease severity scores were positively related to depression in CAPD patients but not in HD patients. These findings suggest that the ESRD Severity Index is a valuable research tool with construct validity.

One-year prospective replication study of an untreated sample of community dysthymia subjects

This study replicates an earlier naturalistic-prospective investigation of nontreatment, community DSM-III-R dysthymia subjects. Major goals were to determine spontaneous remission rates and monitor the stability of psychosocial functioning levels over time. Twenty-four dysthymia subjects were followed for 1 year. Three remissions (13%) were diagnosed at the final interview. At a 4-year diagnostic follow-up contact with the remitters only, one remitter had relapsed and two remained in remission. Subjects were monitored for depressive symptom intensity, personality functioning, general medical distress, cognitive functioning, coping stylistics, interpersonal functioning, quality of their social support resources, and general family functioning. Stable levels of psychosocial functioning were maintained across all measures over the 1-year period. Current psychometric findings confirm the conclusions of the earlier nontreatment prospective study that dysthymia is a chronic mood disorder with stable psychosocial features and is unlikely to remit spontaneously over time.

Comparison of a community dysthymia sample at screening with a matched group of nondepressed community controls

The primary goal of the study was to compare the psychosocial functioning of an untreated, community sample of DSM-III-R dysthymia subjects (N = 24) at screening to that of a matched sample of community nondepressed volunteers (N = 18) with no lifetime or current history of axis I disorders. Subjects were compared across a number of psychosocial indices. The dysthymics were found to be less sociable (introversion) and clinically high on neuroticism-instability, external in regard to their causal attributions, less stable for positive uncontrollable events and more stable and global for negative uncontrollable events, relying more on coping strategies such as wishful thinking and self-blame, more interpersonally submissive and hostile, and to have a poorer social support-resource network. In addition, the dysthymics reported more family dysfunction and a higher rate of negative major life events.

Effects of environmental demands, stress, and mood on health practices

The present study examined how environmental demands, stress, and positive and negative affect were related to health practices. College undergraduates (N = 79) completed measures of stress, mood, and health practices during periods of low and high academic demands. Positive affect was positively related to exercise, nutrition, self-care practices, and overall health practices at two measurement points. Levels of stress (daily hassles, perceived stress, academic stress) increased over time, but increases in daily hassles and perceived stress were unrelated to health practices. Increases in academic demands completed in the previous week were associated with improvements in nutrition and self-care practices, greater drug avoidance, and greater overall health practices. This pattern indicates that a "rebound effect" may occur after high demand periods, during which individuals engage in more health-promoting activities. The results also suggest that the determinants of positive health practices may differ from those of negative health practices.

Fluid noncompliance and symptomatology in end-stage renal disease: Cognitive and emotional variables

Fluid noncompliance in patients with end-stage renal disease (ESRD) is a widespread problem with severe consequences for health. In addition, ESRD patients report considerable stress in relation to their illness and dialysis treatment. The present study examined the role of cognitive and emotional variables in fluid noncompliance, symptomatology, and stress. Fifty hemodialysis patients were assessed (a) on the cognitive variables of locus of control, self-evaluations of their past compliance, and self-efficacy to resist fluid intake and (b) on the emotional variables of depression, anger, and anxiety. Results showed that cognitive variables accounted for fluid noncompliance and predicted future adherence. Patients high in negative emotions complied equally as well as patients low in negative emotions but were found to report substantially more symptomatology and distress associated with their treatment. The implications of these findings for treatment of ESRD patients and future research are discussed.

Hostility and cardiovascular reactivity to stress in women and men

The relationship of Cook Medley hostility scores (Ho) to blood pressure and heart rate reactivity was examined in 56 women and 56 men. Stress was elicited by an unsolvable anagram task that was described as easily solvable. Both men and women scoring high on Ho had greater blood pressure responses to the task. Those scoring high on Ho also reported more anger in response to the tasks, but anger was not associated with blood pressure reactivity. It was concluded that situations evoking suspiciousness and mistrust rather than anger may be necessary to elicit increased blood pressure reactivity among high Ho subjects.

Group participation and survival among patients with end-stage renal disease

All 126 End-Stage Renal Disease (ESRD) patients who entered dialysis between 1971 and 1981 at the Harlem Hospital Center, New York City, were separated into those who had participated in a patient support group and those who had not done so. Patients who engaged in the group activities survived considerably longer than non-participants. Family history of renal disease, psychiatric illness, blood urea nitrogen (BUN), and creatinine were also related to survival, but, education, religion, marital status, and age were not. When 13 psychosocial and physiological covariates were controlled for in a Cox proportional hazard analysis, the group participation effect remained substantial.

Fluid noncompliance and symptomatology in end-stage renal disease: cognitive and emotional variables

Fluid noncompliance in patients with end-stage renal disease (ESRD) is a widespread problem with severe consequences for health. In addition, ESRD patients report considerable stress in relation to their illness and dialysis treatment. The present study examined the role of cognitive and emotional variables in fluid noncompliance, symptomatology, and stress. Fifty hemodialysis patients were assessed (a) on the cognitive variables of locus of control, self-evaluations of their past compliance, and self-efficacy to resist fluid intake and (b) on the emotional variables of depression, anger, and anxiety. Results showed that cognitive variables accounted for fluid noncompliance and predicted future adherence. Patients high in negative emotions complied equally as well as patients low in negative emotions but were found to report substantially more symptomatology and distress associated with their treatment. The implications of these findings for treatment of ESRD patients and future research are discussed.