Authors' Note: This study was funded in part by Grant Number NR009356 from the NINR T32; School of Nursing; University of Pennsylvania; and by Grant Number 1 UL1 RR024150-01 from the National Center for Research Resources NCRR; a component of the National Institutes of Health NIH; and the NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Information on NCRR is available at https://www.ncrr.nih.gov. Information on Reengineering the Clinical Research Enterprise can be obtained from https://nihroadmap.nih.gov/clinicalresearch/ overviewtranslational.asp The authors wish to thank Kelly Derby; currently Clinical Nurse Specialist at the Mayo Clinic; Rochester; MN; for her assistance in compiling statistics.