Probing the Saltwater Immersion Effect on Buried Interfacial Structures between a Sealant and Adhesion Promoter at the Molecular Level.

In this research, we used sum frequency generation vibrational spectroscopy to investigate the buried interface of a thiol-epoxy model aerospace sealant in contact with a silane-based adhesion promoter (6111) following exposures to 3% saltwater at elevated temperatures and elevated temperatures alone. The results suggest that the saltwater caused a change at the interface between the adhesion promoter and sealant, while an elevated temperature of 60 °C itself did not affect the interfacial structure noticeably. Model hydrolyzed and nonhydrolyzed silanes were also used in the study to compare with the adhesion promoter 6111 to understand the interfacial behavior of main silane components in 6111 as well as their potential role in adhesion. The amino silane in 6111 likely segregates more at the sealant/adhesion promoter interface and interacts with the sealant compared to the vinyl silane. The results imply that the saltwater immersion process led to the disordering of the adhesion promoter/sealant interface (caused by interfacial structural randomization), which could potentially have implications for adhesion.

Transformation of Care: Integrating the Registered Nurse Care Coordinator into the Patient-Centered Medical Home.

The purpose of this quality improvement project was to implement and evaluate a care delivery model integrating the registered nurse care coordinator (RNCC) into a family practice that is certified as a patient-centered medical home (PCMH) by the National Committee for Quality Assurance. The initial target population was the 937 patients with diabetes in the family practice. A pre-post design was used to assess changes in patients' diabetic quality indicators after integrating the role of RNCC using existing staff. This 6-month project compared the following diabetic quality indicators: blood pressure < 140/90 mm Hg, hemoglobin A1c ≤ 7, low-density lipoprotein cholesterol < 100 mg/dL, documentation of smoking cessation counseling, and aspirin prescription if existing vascular disease. Yearly documentation of microalbuminurea level, and filament foot and retinal examination was assessed. Patient and health care team satisfaction also was measured. Care coordination interventions included: telehealth, group visits, standardized individual patient education, as well as creative uses of the electronic medical record for workflow changes, daily huddles, and monthly meetings. The results were positive, statistically significant differences in the pre and post scores for A1c (P = .001, n = 790), foot exam (P = .001, n = 850), and microalbumin (P = .01, n = 850). Post intervention, patient and health care team satisfaction with the RNCC role was high (mean scores ≥3 on a 5-point Likert scale). Integrating the RNCC within a multidisciplinary team in the PCMH had a significant positive impact on diabetic quality indicators. Patient and health care team satisfaction with the RNCC role was high.