The association between clinical integration of care and transfer of veterans with acute coronary syndromes from primary care VHA hospitals

BACKGROUND: Few studies report on the effect of organizational factors facilitating transfer between primary and tertiary care hospitals either within an integrated health care system or outside it. In this paper, we report on the relationship between degree of clinical integration of cardiology services and transfer rates of acute coronary syndrome (ACS) patients from primary to tertiary hospitals within and outside the Veterans Health Administration (VHA) system. METHODS: Prospective cohort study. Transfer rates were obtained for all patients with ACS diagnoses admitted to 12 primary VHA hospitals between 1998 and 1999. Binary variables measuring clinical integration were constructed for each primary VHA hospital reflecting: presence of on-site VHA cardiologist; referral coordinator at the associated tertiary VHA hospital; and/or referral coordinator at the primary VHA hospital. We assessed the association between the integration variables and overall transfer from primary to tertiary hospitals, using random effects logistic regression, controlling for clustering at two levels and adjusting for patient characteristics. RESULTS: Three of twelve hospitals had a VHA cardiologist on site, six had a referral coordinator at the tertiary VHA hospital, and four had a referral coordinator at the primary hospital. Presence of a VHA staff cardiologist on site and a referral coordinator at the tertiary VHA hospital decreased the likelihood of any transfer (OR 0.45, 95% CI 0.27–0.77, and 0.46, p = 0.002, CI 0.27–0.78). Conversely, having a referral coordinator at the primary VHA hospital increased the likelihood of transfer (OR 6.28, CI 2.92–13.48). CONCLUSIONS: Elements of clinical integration are associated with transfer, an important process in the care of ACS patients. In promoting optimal patient care, clinical integration factors should be considered in addition to patient characteristics

Orienting the Demixion of a Diblock-copolymer Using 193 nm Interferometric Lithography for the Controlled Deposition of Nanoparticles

DUV interferometric lithography and diblock copolymer self-organization have successfully been combined to provide a simple and highly collective nanopatterning technique enabling the organization of nanoparticles over several orders of magnitude, from nanometre to millimetre. The nanostructural changes at the surface of the polymer film after thermal annealing have been monitored by AFM and the process parameters optimized for obtaining a long-range organization of the lamellar domains. In particular, the impact of the annealing conditions and geometric parameters of the substrate patterns have been investigated. The nanopatterns resulting from the lamellar demixion of (PS-b-MMA) were used for a controlled deposition of nanoparticles. The affinity of the hydrophobic particles for the PS block was demonstrated, opening new doors towards the preparation of high-density arrays of nanoparticles with potential applications in data storage