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Background: Social care integration refers to the incorporation of activities into health systems that assist patients with health-related social needs (HRSNs) that negatively impact the health outcomes of their patients, such as food insecurity or homelessness. Social care integration initiatives are becoming more common. The COVID-19 pandemic strained health systems while simultaneously increasing levels of unmet social needs. Objective: To describe the effects of the COVID-19 pandemic on established social care delivery in a primary care setting. Design: We used qualitative semi-structured interviews of stakeholders to assess barriers and facilitators to social care delivery in the primary care setting during the COVID-19 health emergency. Data was analyzed using a hybrid inductive/deductive thematic analysis approach with both the Consolidated Framework for Implementation Research (CFIR) and the Screen-Navigate-Connect-Address-Evaluate model of social care integration. Setting: Two safety-net, hospital-based primary care clinics with established screening for food insecurity, homelessness, and legal needs. Participants: Six physicians, six nurses, six members of the social work team (clinical social workers and medical case workers), six community health workers, and six patients (total N = 30) completed interviews. Results: Four major themes were identified. (1) A strained workforce experienced challenges confronting increased levels of HRSNs. (2) Vulnerable populations experienced a disproportionate negative impact in coping with effects of the COVID-19 pandemic on HRSNs. (3) COVID-19 protections compounded social isolation but did not extinguish the sense of community. (4) Fluctuations in the social service landscape led to variable experiences. Conclusions: The COVID-19 pandemic disrupted established social care delivery in a primary care setting. Many of the lessons learned about challenges to social care delivery when health systems are strained are important considerations that can inform efforts to expand social care delivery. [ABSTRACT FROM AUTHOR]

Objective: Alcohol use disorder (AUD) is a leading cause of preventable death and is a frequent diagnosis in the emergency department (ED). Treatment in the ED, however, typically focuses on managing the sequelae of AUD, such as acute withdrawal, rather than addressing the underlying addiction. For many patients, these ED encounters are a missed opportunity to connect with medication for AUD. In 2020, our ED created a pathway to offer patients with AUD treatment with naltrexone (NTX) during their ED visit. The aim of this study was to identify what barriers and facilitators patients perceive to NTX initiation in the ED. Methods: Adopting the theoretical framework of the behavior change wheel (BCW), we conducted qualitative interviews with patients to elicit their perspectives on ED initiation of NTX. Interviews were coded and analyzed using both inductive and deductive approaches. Themes were categorized according to patients' capabilities, opportunities, and motivations. Barriers were then mapped through the BCW to design interventions that will improve our treatment pathway. Results: Twenty‐eight patients with AUD were interviewed. Facilitators of accepting NTX included having recently experienced sequelae of AUD, rapid management of withdrawal symptoms by the ED provider, having a choice between intramuscular and oral formulations of the medication, and experiencing positive interactions in the ED that destigmatized the patient's AUD. Barriers to accepting treatment included lack of provider knowledge about NTX, dependence on alcohol as self‐treatment for psychiatric trauma and physical pain, perceived discriminatory treatment and stigma about AUD, aversion to potential side effects, and lack of access to continued treatment. Conclusions: Initiation of treatment of AUD with NTX in the ED is acceptable to patients and can be facilitated by knowledgeable ED providers who create a destigmatizing environment, effectively manage withdrawal symptoms, and connect patients to providers who will continue treatment. [ABSTRACT FROM AUTHOR]

In this report, we explored the effect of incorporating ureidopyrimidone (UPy) linkers in a series of polyimides (PIs) previously studied in our laboratory. The polymers consist of an aromatic diamine monomer with a methylene linker, 4,4′'‐methylenebis (2,6‐dimethylaniline), used to make a robust main chain along with aliphatic polyetherdiamine backbone linkers to decrease rigidity. The polymers were designed to exhibit thermal properties in between those of conventional aromatic PIs and polymers with wholly aliphatic ether diamine links, with an aim to improve the mechanical characteristics. Through dynamic mechanical analysis and differential scanning calorimetry, it is shown that the UPy linkers with their four‐hydrogen bond sites are introduced to connect the chains in series. The connection strengthens the chain interactions and increases the range of the thermal and mechanical properties of the PI. Furthermore, the connecting regions are an important component to preserve the thermal stability of PIs while maintaining the processability. The polymers were characterized by FTIR, nuclear magnetic resonance, GPC, thermogravimetric analysis, differential scanning calorimetry, dynamic mechanical analysis, microhardness, and tensile testing. POLYM. ENG. SCI., 59:2231–2246, 2019. © 2019 Society of Plastics Engineers [ABSTRACT FROM AUTHOR]

Recently, we have studied polyimides (PIs) synthesized by incorporating an aromatic diamine monomer with a methylene linker, 4,4′‐methylenebis(2,6‐dimethylaniline), to make a robust main chain along with aliphatic polyetherdiamine backbone linkers to reduce rigidity. In this report, we incorporate a urea linkage into these materials in order to observe the effect of additional hydrogen bonding. The polymers are designed to exhibit thermal properties in between those of conventional aromatic PIs and polymers with wholly aliphatic ether diamine links. Herein, we demonstrate that the addition of 1,6 hexamethylene diisocyanate and the increase of hydrogen bonds at the urea linkage can be used to improve the thermal and mechanical properties of the PI. Furthermore, the imide ring is an important component to maintain the thermal stability characteristics in polyimide–polyurea hybrids. The polymers were characterized by FTIR, thermomechanical and calorimetric analysis, microhardness, and tensile testing. POLYM. ENG. SCI., 59:1948–1959, 2019. © 2019 Society of Plastics Engineers [ABSTRACT FROM AUTHOR]

In a previous study on polyimides, we incorporated an aromatic diamine monomer with a methylene linker, 4,4′‐methylenebis(2,6‐dimethylaniline), to make a robust main chain along with aliphatic polyetherdiamine backbone linkers to decrease rigidity. In this report, we explore the behavior of crystalline regions provided by the organized packing of polyethylene oxide into the formerly characterized polymers. The polymers were designed to exhibit thermal properties in between those of conventional aromatic polyimides and polymers with wholly aliphatic ether diamine links, with a target to improve the mechanical characteristics. Through dynamic mechanical analysis and differential scanning calorimetry, it is shown that the incorporation of polyethylene oxide diamine and the removal of methyl pending groups serve to improve the organized packing of the chains. All of this allows for a broader range in tenability of thermal and mechanical properties of the polyimide. Furthermore, the crystalline regions are an important component to maintain the temperature stability of polyimide while maintaining the processability. The polymers are characterized by Fourier‐transform infrared spectroscopy, thermomechanical and calorimetric analysis, microhardness measurements, tensile testing, and wide‐angle X‐ray scattering. POLYM. ENG. SCI., 59:1919–1932, 2019. © 2019 Society of Plastics Engineers [ABSTRACT FROM AUTHOR]

In this work, we synthesized polyimides by incorporating an aromatic diamine monomer with a methylene linker, 4,4'‐methylenebis(2,6‐dimethylaniline) (MBDMA), to make a robust main chain along with aliphatic polyetherdiamine backbone linkers to reduce rigidity. We designed the polymers to exhibit thermal properties in between those of conventional aromatic polyimides and polymers with wholly aliphatic ether diamine links. Through dynamic mechanical analysis and differential scanning calorimetry, it is shown that control of the molar ratios of the aromatic MBDMA (4,4'‐methylenebis(2,6‐dimethylaniline)) and the composition and size of the aliphatic polyetherdiamine can be used to tune the glass transition. The polymers were characterized by GPC, FTIR, NMR, thermomechanical and calorimetric analysis, and microhardness testing. POLYM. ENG. SCI., 59:221–232, 2019. © 2018 Society of Plastics Engineers [ABSTRACT FROM AUTHOR]