Client functionality, filial abuse and agency interventions

This study explores the relationship between the client\u27s functionality, alleged filial abuse, and the effect of interventions as they relate to future Adult Protective Services (APS) referrals

No association between intravenous fluid volume and endothelial glycocalyx shedding in patients undergoing resuscitation for sepsis in the emergency department

Endothelial glycocalyx (EG) shedding is associated with septic shock and described following intravenous (IV) fluid administration. To investigate the possible impact of IV fluids on the pathobiology of septic shock we investigated associations between biomarkers of EG shedding and endothelial cell activation, and relationships with IV fluid volume. Serum samples were obtained on admission (T0) and at 24 h (T24) in patients undergoing haemodynamic resuscitation for suspected septic shock in the emergency department. Biomarkers of EG shedding—Syndecan-1 (Syn-1), Syndecan-4 (Syn-4), Hyaluronan, endothelial activation—Endothelin-1 (ET-1), Angiopoeitin-2 (Ang-2), Vascular Endothelial Growth Factor Receptor-1(VEGF-1) and leucocyte activation/inflammation—Resistin, Neutrophil Gelatinase Associated Lipocalin (NGAL) and a marker of cardiac stretch—Pro-Atrial Natriuretic Peptide (Pro-ANP) were compared to the total IV fluid volume administered using Tobit regression. Data on 86 patients (52 male) with a mean age of 60 (SD 18) years were included. The mean fluid volume administered to T24 was 4038 ml (SD 2507 ml). No significant association between fluid volume and Pro-ANP or any of the biomarkers were observed. Syn-1 and Syn-4 were significantly correlated with each other (Spearman Rho 0.43, p \u3c 0.001) but not with Hyaluronan. Syn-1 and Syn-4 both correlated with VEGFR-1 (Rho 0.56 and 0.57 respectively, p \u3c 0.001) whereas Hyaluronan correlated with ET-1 (Rho 0.43, p \u3c 0.001) and Ang-2 (Rho 0.43, p \u3c 0.001). There was no correlation between Pro-ANP and any of the EG biomarkers. Distinct patterns of association between biomarkers of EG shedding and endothelial cell activation were observed among patients undergoing resuscitation for sepsis. No relationship between IV fluid volume and Pro-ANP or any of the other biomarkers was observed

Advanced proton-exchange materials for energy efficient fuel cells.

The ''Advanced Proton-Exchange Materials for Energy Efficient Fuel Cells'' Laboratory Directed Research and Development (LDRD) project began in October 2002 and ended in September 2005. This LDRD was funded by the Energy Efficiency and Renewable Energy strategic business unit. The purpose of this LDRD was to initiate the fundamental research necessary for the development of a novel proton-exchange membranes (PEM) to overcome the material and performance limitations of the ''state of the art'' Nafion that is used in both hydrogen and methanol fuel cells. An atomistic modeling effort was added to this LDRD in order to establish a frame work between predicted morphology and observed PEM morphology in order to relate it to fuel cell performance. Significant progress was made in the area of PEM material design, development, and demonstration during this LDRD. A fundamental understanding involving the role of the structure of the PEM material as a function of sulfonic acid content, polymer topology, chemical composition, molecular weight, and electrode electrolyte ink development was demonstrated during this LDRD. PEM materials based upon random and block polyimides, polybenzimidazoles, and polyphenylenes were created and evaluated for improvements in proton conductivity, reduced swelling, reduced O{sub 2} and H{sub 2} permeability, and increased thermal stability. Results from this work reveal that the family of polyphenylenes potentially solves several technical challenges associated with obtaining a high temperature PEM membrane. Fuel cell relevant properties such as high proton conductivity (>120 mS/cm), good thermal stability, and mechanical robustness were demonstrated during this LDRD. This report summarizes the technical accomplishments and results of this LDRD

Pharmacological evaluation of novel bioisosteres of an adamantanyl benzamide P2X7 receptor antagonist

Adamantanyl benzamide 1 was identified as a potent P2X7R antagonist but failed to progress further due to poor metabolic stability. We describe the synthesis and SAR of a series of bioisosteres of benzamide 1 to explore improvements in the pharmacological properties of this lead. Initial efforts investigated a series of heteroaromatic bioisosteres, which demonstrated improved physicochemical properties but reduced P2X7R antagonism. Installation of bioisosteric fluorine on the adamantane bridgeheads was well tolerated and led to a series of bioisosteres with improved physicochemical properties and metabolic stability. Trifluorinated benzamide 34 demonstrated optimal physicochemical parameters, superior metabolic stability (ten times longer than lead benzamide 1), and an improved physicokinetic profile and proved effective in the presence of several known P2X7R polymorphisms

Using electron density to predict synthon formation in a 4-hydroxybenzoic acid : 4,4'-bipyridine co-crystal

Experimental charge density distribution studies complemented by quantum mechanical theoretical calculations of 4-hydroxybenzoic acid (4HBA) (1), 4,4'-bipyridine (44BP) (2) and one polymorphic form of the co-crystal containing 4HBA and 44BP molecules in a 2:1 ratio (3), have been carried out via high resolution single-crystal X-ray diffraction. Synthon formation was found to be the main driving force for crystallisation in both (1) and (3) with a carboxylic acid homosynthon present in (1) and a heterosynthon in (3) comprised of a carboxylic acid from 4HBA and a pyridine nitrogen and aromatic hydrogen from 44BP. Topological analysis revealed the bonding in the homosynthon to be stronger than the heterosynthon (305.88 versus. 193.95 kJ mol-1) with a greater number of weak interactions in (3) helping to stabilise the structure. The distance from the hydrogen and hydrogen bond acceptor to the bond critical point (bcp) was also found to be a significant factor in determining bond strength, potentially having a greater effect than lone pair directionality. Two different methods of lattice energy calculations were carried out and both methods found (1) to be more stable than (3) by ~40 and 10 kJmol-1 for the LATEN and PIXEL methods respectively. Energy framework diagrams reveal (1) to be dominated by coulombic forces while both coulombic and dispersion forces are prominent in (3) contributing equally to the lattice energy. This study examined the utility of homosynthons and heterosynthons in future crystal engineering endeavours and concluded that although in this case the single molecule crystal was more thermodynamically stable, the asymmetry of the co-crystal system allowed it to form a wider range of interactions resulting in only a small reduction in stability. This highlights the potential of using heterosynthons to develop co-crystals to improve pharmaceuticals. These findings highlight the utility of high resolution single crystal X-ray crystallography in rationalising observed physical properties

An experimental and theoretical charge density study of theophylline and malonic acid cocrystallization

The pharmaceutical agent theophylline (THEO) is primarily used as a bronchodilator and is commercially available in both tablet and liquid dosage forms. THEO is highly hygroscopic, reducing its stability, overall shelf-life, and therefore usage as a drug. THEO and dicarboxylic acid cocrystals were designed by Trask et al. in an attempt to decrease the hygroscopic behaviour of THEO; cocrystallisation of THEO with malonic acid (MA) did not improve the hygroscopic stability of THEO in simulated atmospheric humidity testing. The current study employed high-resolution X-ray crystallography, and Density Functional Theory (DFT) calculations to examine the electron density distribution (EDD) changes between the cocrystal and its individual components. The EED changes identified the reasons why the THEO:MA cocrystal did not alter the hygroscopic profile of THEO. The cocrystal was equally porous, with atomic packing factors (APF) similar to those of THEO 0.73 vs. 0.71, respectively. The THEO:MA (1) cocrystal structure is held together by an array of interactions; a heterogeneous synthon between the imidazole and a carboxylic fragment stabilising the asymmetric unit, a pyrimidine-imidazole homosynthon, and an aromatic cycle stack between two THEO moieties have been identified, providing 9.7–12.9 kJ mol−1 of stability. These factors did not change the overall relative stability of the cocrystal relative to its individual THEO and MA components, as shown by cocrystal (1) and THEO being equally stable, with calculated lattice energies within 2.5 kJ mol−1 of one other. The hydrogen bond analysis and fragmented atomic charge analysis highlighted that the formation of (1) combined both the EDD of THEO and MA with no net chemical change, suggesting that the reverse reaction — (1) back to THEO and MA — is of equal potential, ultimately producing THEO hydrate formation, in agreement with the work of Trask et al. These results highlight that a review of the EDD change associated with a chemical reaction can aid in understanding cocrystal design. In addition, they indicate that cocrystal design requires further investigation before becoming a reliable process, with particular emphasis on identifying the appropriate balance of synthon engineering, weak interactions, and packing dynamics

Understanding hygroscopicity of theophylline via a novel cocrystal polymorph: a charge density study

The charge density distribution in a novel cocrystal (1) complex of 1,3-dimethylxanthine (theophylline) and propanedioic acid (malonic acid) has been determined. The molecules crystallize in the triclinic, centrosymmetric space group P1̅, with four independent molecules (Z = 4) in the asymmetric unit (two molecules each of theophylline and malonic acid). Theophylline has a notably high hygroscopic nature, and numerous cocrystals have shown a significant improvement in stability to humidity. A charge density study of the novel polymorph has identified interesting theoretical results correlating the stability enhancement of theophylline via cocrystallization. Topological analysis of the electron density highlighted key differences (up to 17.8) in Laplacian (∇2ρ) between the experimental (EXP) and single-point (SP) models, mainly around intermolecular-bonded carbonyls. Further investigation via molecular electrostatic potential maps reaffirmed that the charge redistribution enhanced intramolecular hydrogen bonding, predominantly for N(2′) and N(2) (61.2 and 61.8 kJ mol–1, respectively). An overall weaker lattice energy of the triclinic form (−126.1 kJ mol–1) compared to that of the monoclinic form (−133.8 kJ mol–1) suggests a lower energy threshold to overcome to initiate dissociation. Future work via physical testing of the novel cocrystal in both dissolution and solubility will further solidify the correlation between theoretical and experimental results

Analyzing hydration differences in cocrystal polymorphs: high-resolution X-ray investigation of caffeine-glutaric acid cocrystals

Two polymorphic forms of caffeine (CAF)–glutaric acid (GLU) cocrystals have been studied via high-resolution X-ray crystallography and Bader’s quantum theory of atoms in molecules (QTAIM). For both the monoclinic, 1, and triclinic, 2, systems the experimental charge density distributions of the 1:1 ratio of CAF and GLU polymorphs have been determined and compared. Previous studies have determined that 1 is less stable than 2, in relative humidity (RH) testing. A topological analysis of the electron density distribution (EDD) revealed little difference between the two polymorph internal systems. The packing densities (0.76 vs 0.74) and lattice energies (−101.1 vs −107.1 kJ mol–1) of 1 and 2, respectively, are nearly equivalent, implying that the differences in hygroscopicity between the two polymorphs are not due to crystal lattice porosity or stability. A topological analysis of the number and strength of hydrogen bonds for 1 and 2 revealed nine hydrogen bonds in both polymorphs. “Classical” (O–H···X) hydrogen bonds were similarly present in both polymorphs, stabilizing the cocrystals. However, the sum of the stability produced from the “nonclassical” (C–H···X) bonds is higher in 2: −27.6 vs −38.2 kJ mol–1 for 1 and 2, respectively. One of the nine hydrogen bonds in 1 and 2 varies from the others, caused by the torsional rotation of the aliphatic carbon chain in GLU. This bond is critical for packing stabilization, creating a parallelogram-like packing arrangement in 2 in comparison to ribboning in 1. A Hirshfeld surface analysis found that the percentages of O–H···X hydrogen bonds were nearly identical in 1 and 2 (23.9% vs 22.1%); however, the H···H contacts were higher in 2 (61.4% vs 65.8% for 1 and 2, respectively), suggesting that more hydrogen-based contacts require competitive displacement by water in the hydration of 2 in comparison to 1. Additionally, a stabilizing aromatic cycle stack between CAF molecules is present in 2 due to the varied parallelogram packing arrangement, which was absent in 1; this provided ∼11.3 kJ mol–1 of stability to the system of 2. The solid-state entropies and molecular dipole moments (MDMs) of 1 and 2 supported the relative stability of the individual polymorphs, with 1 having a higher entropy and dipole moment in comparison to 2 (123.2 vs 112.8 J K–1 mol–1 and 7.45 and 4.93 D for 1 and 2, respectively), implying that it has the potential to hydrate more rapidly. These findings are in good agreement with previous experimental RH stability studies, giving further insight into the information gained from thermally averaged ground-state crystal electron density data

Increased Asymmetric Dimethylarginine in Severe Falciparum Malaria: Association with Impaired Nitric Oxide Bioavailability and Fatal Outcome

Asymmetrical dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase (NOS), is a predictor of mortality in critical illness. Severe malaria (SM) is associated with decreased NO bioavailability, but the contribution of ADMA to the pathogenesis of impaired NO bioavailability and adverse outcomes in malaria is unknown. In adults with and without falciparum malaria, we tested the hypotheses that plasma ADMA would be: 1) increased in proportion to disease severity, 2) associated with impaired vascular and pulmonary NO bioavailability and 3) independently associated with increased mortality. We assessed plasma dimethylarginines, exhaled NO concentrations and endothelial function in 49 patients with SM, 78 with moderately severe malaria (MSM) and 19 healthy controls (HC). Repeat ADMA and endothelial function measurements were performed in patients with SM. Multivariable regression was used to assess the effect of ADMA on mortality and NO bioavailability. Plasma ADMA was increased in SM patients (0.85 µM; 95% CI 0.74–0.96) compared to those with MSM (0.54 µM; 95%CI 0.5–0.56) and HCs (0.64 µM; 95%CI 0.58–0.70; p<0.001). ADMA was an independent predictor of mortality in SM patients with each micromolar elevation increasing the odds of death 18 fold (95% CI 2.0–181; p = 0.01). ADMA was independently associated with decreased exhaled NO (rs = −0.31) and endothelial function (rs = −0.32) in all malaria patients, and with reduced exhaled NO (rs = −0.72) in those with SM. ADMA is increased in SM and associated with decreased vascular and pulmonary NO bioavailability. Inhibition of NOS by ADMA may contribute to increased mortality in severe malaria