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2, where 5 = maximal readiness for change. Facilitators included support from leadership and clinical champions, active telehealth programs, and an understanding and appreciation of the program and the resources needed. At all sites, however, technical issues negatively affected adoption; these included a suboptimal information technology infrastructure, which led to the inoperability of the app at two sites, and technical inefficiencies related to users' unfamiliarity with new devices and inconsistent internet access. Conclusions Although a strong commitment to change and a confidence to effect change existed, these alone were insufficient to surmount barriers to implementation effectiveness. Clinical Trials Registration NCT03241589.Background Management of bile duct stones is variable. Selection of the appropriate treatment modality based on identifiable risk factors can increase the chances of a successful outcome. The aim of this study is to identify factors affecting outcomes of a laparoscopic bile duct exploration. Methods Retrospective data analysis of consecutive laparoscopic bile duct explorations over a period of 13 years at a district general hospital. Results The total number of patients in the study was 85. Elective explorations were 56 while 29 were emergency procedures. The mean operative time was 154 minutes. The conversion rate was 14% with failure to extract stones being the most common reason. Forty-two percent of conversions were in nonelective procedures and 17% in previous endoscopic retrograde cholangiopancreatography (ERCP) failures. Eleven percent patients had a transcystic clearance of bile duct and the largest stone removed transcystic was 5 mm. The largest stone removed by a laparoscopic choledochotomy was 15 mm and stones >20 mm were removed on conversion. Seven patients (8%) had a postoperative bile leak, 4 of these required a postoperative ERCP stent and radiological drainage while 3 required a reoperation. Three patients had retained stones treated by postoperative ERCP. Conclusion Emergency procedures, increasing number and size of stones, previous failed ERCP are factors that contribute to the outcomes of a laparoscopic bile duct exploration. The chances of a successful exploration can be improved by appropriate patient and procedure selection and preparation based on identification of these factors.Background Understanding challenges of family caregivers within specific palliative care contexts is needed. Objective To describe the challenges of family caregivers of patients with cancer who receive outpatient palliative care. Proteasome inhibitor Methods We summarized the most common and most challenging problems for 80 family caregivers of cancer patients receiving outpatient palliative care in the midwestern United States. Results Caregiver worry and difficulty managing side effects or symptoms other than pain, constipation, and shortness of breath were most common. "Financial concerns" was cited most as a "top 3" problem. Almost half of caregivers reported "other" problems, including family members, patient physical function, care coordination, and patient emotional state. Conclusions The most common and most challenging problems of family caregivers of cancer patients receiving outpatient palliative care may differ from those experienced in other serious illness care contexts. Comparative studies on caregiver problems across the cancer care continuum can help develop and refine interventions.The separation of styrene (ST) and ethylbenzene (EB) mixtures is of great importance in the petrochemical and plastics industries. Current technology employs multiple cycles of energy-intensive distillation due to the very close boiling points of ST and EB. Here, we show that the molecular sieving properties of easily scalable and stable trianglimine crystals offer ultrahigh selectivity (99%) for styrene separation. The unique molecular sieving properties of trianglimine crystals are corroborated by DFT calculations, suggesting that the incorporation of the nonplanar EB requires a significant deformation of the macrocyclic cavity whereas the planar ST can be easily accommodated in the cavity.Macrolides are among the most widely prescribed antibiotics, particularly for bacterial lung infections, due to their favorable safety, oral bioavailability, and spectrum of activity against Gram-positive pathogens such as Streptococcus pneumoniae, the most common cause of bacterial pneumonia. Their utility against Gram-negative bacteria is extremely limited and does not include the Enterobacteriaceae or other ESKAPE pathogens. With the increasing development of resistance to current therapies and the lack of safe, oral options to treat Gram-negative infections, extended-spectrum macrolides have the potential to provide valuable treatment options. While the bacterial ribosome, the target of macrolides, is highly conserved across Gram-positive and Gram-negative bacteria, traditional macrolides do not possess the proper physicochemical properties to cross the polar Gram-negative outer membrane and are highly susceptible to efflux. As with most natural product-derived compounds, macrolides are generally preparedlasses and Gram-positive macrolides.The structure and functions of natural organisms provide great inspirational sources for designing and manufacturing bionic coatings, which hold a distinguished scientific promise to tackle challenges facing humans. In this work, we report a facile and controllable approach to prepare various hexagonal periodic array VO2 thin films by simply manipulating the speed of the dip-coating operation. The hexagonal cellular-structured VO2 surface delivered the best thermochromic performance with a Tlum of 79.34% and a ΔTsol of 9.87%. Impressively, superhydrophobic and thermochromic properties could be integrated into hexagonal semi-dome thin films (with a Tlum of 70.9%, a ΔTsol of 9.3%, and a water contact angle of 150°) without any post-treatment by low-surface-energy chemicals, which hold considerable potential for application in multifunctional smart windows. Moreover, based on the Cassie-Baxter mode and finite-difference time-domain calculations, the dependence of the thermochromic and wettability performances on the VO2 structure has been investigated in this study.Chiral α-branched amines are common structural motifs in functional materials, pharmaceuticals, and chiral catalysts. Therefore, developing efficient methods for preparing compounds with these privileged scaffolds is an important endeavor in synthetic chemistry. Herein, we describe an atom-economical, modular method for a nickel-catalyzed enantioselective α-alkenylation of readily available linear N-sulfonyl amines with alkynes to afford a wide variety of allylic amines without the need for exogenous oxidants, reductants, or activating reagents. The method provides a platform for constructing chiral α-branched amines as well as derivatives such as α-amino amides and β-amino alcohols, which can be conveniently accessed from the newly introduced alkene. Given the generality, versatility, and high atom economy of this method, we anticipate that it will have broad synthetic utility.Controlled patterning of nanoparticles on bioassemblies enables synthesis of complex materials for applications in optics, nanoelectronics, and sensing. Biomolecular self-assembly offers molecular control for engineering patterned nanomaterials, but current approaches have been limited in their ability to combine high nanoparticle coverage with generality that enables incorporation of multiple nanoparticle types. Here, we synthesize photonic materials on crystalline two-dimensional (2D) protein sheets using orthogonal bioconjugation reactions, organizing quantum dots (QDs), gold nanoparticles (AuNPs), and upconverting nanoparticles along the surface-layer (S-layer) protein SbsB from the extremophile Geobacillus stearothermophilus. We use electron and optical microscopy to show that isopeptide bond-forming SpyCatcher and SnoopCatcher systems enable the simultaneous and controlled conjugation of multiple types of nanoparticles (NPs) at high densities along the SbsB sheets. These NP conjugation reactions are orthogonal to each other and to Au-thiol bond formation, allowing tailorable nanoparticle combinations at sufficient labeling efficiencies to permit optical interactions between nanoparticles. Fluorescence lifetime imaging of SbsB sheets conjugated to QDs and AuNPs at distinct attachment sites shows spatially heterogeneous QD emission, with shorter radiative decays and brighter fluorescence arising from plasmonic enhancement at short interparticle distances. This specific, stable, and efficient conjugation of NPs to 2D protein sheets enables the exploration of interactions between pairs of nanoparticles at defined distances for the engineering of protein-based photonic nanomaterials.LaF3 and NaLaF4 crystals were selectively precipitated in the SiO2-Al2O3-AlF3-Na2O-NaF-LaF3-ErF3 glass system by adjusting their compositions. The structural evolution at the atomic level driven by heat treatment and glass compositions was studied using the state-of-the-art magic-angle spinning nuclear magnetic resonance technique. From a comprehensive local structural study, we found that LaF3 and NaLaF4 crystals compete in crystallization in these glasses. The crystallization ability of NaLaF4 increases with the increase of the content of Na+ ions within the F-enriched phase, but for LaF3 crystals, it is reverse. These two crystals can be selectively precipitated in the glasses by adjusting the content of these Na+ ions within the F-enriched phase. When the crystallization ability of these two crystals becomes similar, none of them can be precipitated due to their mutual interference in crystallization. Intense single green upconversion luminescence occurs in glasses precipitating LaF3 or NaLaF4 crystals. The underlying relationship between compositions, structures, crystallization, and upconversion luminescence properties is unearthed based on the structural evolution, crystallization mechanism, and luminescence properties. This relationship will facilitate the compositional design of these kinds of glasses. It is inferred that it will be better to precipitate LaF3 rather than NaLaF4 crystals for achieving highly efficient upconversion luminescence.The combination of (AlCp*)4, a source of monomeric AlCp* at elevated temperatures, with DipTerPnPMe3 (Pn = P, As), so-called pnicta-Wittig reagents, at 80 °C cleanly gives the pnictaalumenes DipTerPnAlCp* with polarized Pn-Al double bonds and intramolecular stabilization through interactions of Al with a flanking aryl group of the terphenyl substituent on Pn. In contrast, using MesTerPPMe3, the reaction with 2 equiv of AlCp3t or AlCp* afforded the three-membered 2π-aromatic ring systems MesTerP(AlCp x )2 (x = 3t, *).Single and a few atomic-layer molybdenum disulfide (MoS2) is a promising material in the fields of hydrogen generation, battery, supercapacitor, and environmental protection, owing to the outstanding electronic, optical, and catalytic properties. Although many approaches have been developed for exfoliation of MoS2 sheets, it is still essential to develop simple, convenient, and environmental friendly exfoliation methods. More importantly, the microscopic exfoliation process and the mechanism are still not clear, limiting a deeper understanding of the exfoliation. Herein, we develop a convenient and clean method for exfoliation of the 2H phase MoS2 (2H-MoS2) deposited on an indium tin oxide (ITO) surface. Importantly, the exfoliation process is observed directly and continuously under an optical microscope to reveal the detailed exfoliation process and mechanism. As illustrated, the light illumination triggers the exfoliation of the 2H-MoS2 sheets, and the presence of water is essential in this exfoliation process.