A qualitative process evaluation of a diabetes navigation program embedded in an endocrine specialty center in rural Appalachian Ohio.

BACKGROUND: Diabetes in the United States has reached epidemic proportions and the people of Appalachia have been disproportionately affected by this disease. Strategies that complement standard diabetes care are critically important to mitigate the risk of complications, reduce health expenditures, and improve the quality of life of patients living in rural Appalachia. The purpose of this study was to conduct a qualitative process evaluation of a patient navigation program for diabetes after its first year of implementation. METHODS: The process evaluation assessed how the Diabetes Navigation Program was delivered as well as how it was experienced by the navigators, providers, health administrators, and office staff at an endocrine specialty center in rural Appalachian Ohio. We employed total population sampling to conduct in-depth, face-to-face interviews with all providers, health administrators, staff, and navigators at a Diabetes Endocrine Center. Interviews were transcribed, coded, and analyzed via content and thematic analyses using NVivo 11 software. RESULTS: Seventeen individuals (providers n = 5, health administrators n = 4, office staff members n = 3, and navigators n = 5) participated in in-depth, face-to-face interviews (age = 44.7 ± 11.6 years, 82.4% female, 94.1% white, 13.3 ± 9.6 years work experience). Fidelity of implementation: The navigation team carried out most of the activities denoted in the Work Plan, therefore the program was implemented somewhat successfully. Qualitative analysis revealed three themes: 1) The navigator addresses sources of health disparities: All participants described the role of the diabetes navigator as someone who is knowledgeable about diabetes and able to identify and address health disparities. 2) The navigators are the eyes in the community and the patients' homes: Navigators offered providers and clinic staff a rare glimpse into the personal lives of patients, which led to the identification of unrecognized barriers. 3) Difficulties with cross-system integration of services: Differences in the organizational culture and vision of the specialty center and navigation office contributed to systemic barriers. CONCLUSIONS: Overall, this process evaluation highlights the importance of coordinating providers, health administrators, medical office staff, and navigators to address barriers to diabetes care. Forthcoming research is needed to document the clinical effectiveness and sustainability of the Diabetes Navigation Program in rural Appalachia.

Characterization of Functional Materials Using Coherence Scanning Interferometry and Environmental Chambers.

Functional materials are challenging to characterize because of the presence of small structures and inhomogeneous materials. If interference microscopy was initially developed for use for the optical profilometry of homogeneous, static surfaces, it has since been considerably improved in its capacity to measure a greater variety of samples and parameters. This review presents our own contributions to extending the usefulness of interference microscopy. For example, 4D microscopy allows real-time topographic measurement of moving or changing surfaces. High-resolution tomography can be used to characterize transparent layers; local spectroscopy allows the measurement of local optical properties; and glass microspheres improve the lateral resolution of measurements. Environmental chambers have been particularly useful in three specific applications. The first one controls the pressure, temperature, and humidity for measuring the mechanical properties of ultrathin polymer films; the second controls automatically the deposition of microdroplets for measuring the drying properties of polymers; and the third one employs an immersion system for studying changes in colloidal layers immersed in water in the presence of pollutants. The results of each system and technique demonstrate that interference microscopy can be used for more fully characterizing the small structures and inhomogeneous materials typically found in functional materials.

Coarse-Grain Simulations of Solid Supported Lipid Bilayers with Varying Hydration Levels.

Supported lipid bilayers (SLBs) are a very popular system for the study of biomimetic membranes. Understanding of the interactions between the solid substrate and the lipid membrane opens pathways to the design of new materials with fine-tunable properties. While it is possible to study SLBs via molecular dynamics (MD) simulations, difficulties still remain for these strategies; in particular, the confined water layer thickness and structure are difficult to reproduce in simulations. We have explored different coarse-grained (CG) models for the membrane/support interaction, and their impact on the substrate hydration level. Our results highlight the relevance of including long-range interactions in CG-MD simulations of fluid SLBs. Modeled neutron reflectivity curves are deduced from the structures obtained by molecular simulations, and substrate parameters are optimized to match the experimental and modeled reflectivity curves. We expect our coarse-grained approach to open new perspectives for the simulations of SLBs of increasing complexity, including lipid layers of complex compositions, or adsorbed lipidic layers on patterned surfaces.