Economic value of podiatry service in limb salvage alliance.

OBJECTIVE/BACKGROUND: Over the past decade, multidisciplinary "toe and flow" programs have gained great popularity, with proven benefits in limb salvage. Many vascular surgeons have incorporated podiatrists into their practices. The viability of this practice model requires close partnership, hospital support, and financial sustainability. We intend to examine the economic values of podiatrists in a busy safety-net hospital in the Southwest United States. METHODS: An administrative database that captured monthly operating room (OR) cases, clinic encounters, in-patient volume, and total work relative value units (wRVUs) in an established limb salvage program in a tertiary referral center were examined. The practice has a diverse patient population with >30% of minority patients. During a period of 3 years, there was a significant change in the number of podiatrists (from 1 to 4) within the program, whereas the clinical full-time employees for vascular surgeons remained relatively stable. RESULTS: The limb salvage program experienced >100% of growth in total OR volumes, clinic encounters, and total wRVUs over a period of 4 years. A total of 35,591 patients were evaluated in a multidisciplinary limb salvage clinic, and 5535 procedures were performed. The initial growth of clinic volume and operative volume (P < .01) were attributed by the addition of vascular surgeons in year one. However, recruitment of podiatrists to the program significantly increased clinic and OR volume by an additional 60% and >40%, respectively (P < .01) in the past 3 years. With equal number of surgeons, podiatry contributed 40% of total wRVUs generated by the entire program in 2019. Despite the fact that that most of the foot and ankle procedures that were regularly performed by vascular surgeons were shifted to the podiatrists, vascular surgeons continued to experience an incremental increase in operative volume and >10% of increase in wRVUs. CONCLUSIONS: This study shows that the value of close collaboration between podiatry and vascular in a limb salvage program extends beyond a patient's clinical outcome. A financial advantage of including podiatrists in a vascular surgery practice is clearly demonstrated.

TiO2 nanowire electron transport pathways inside organic photovoltaics.

Charge transport is one of the five main steps in the operation of organic photovoltaics, but achieving balanced hole and electron transport with high mobility has been challenging in devices. Here, we report improved charge transport in organic photovoltaics via incorporation of nanostructured inorganic electron transport materials into the active layers of devices. Co-depositing TiO2 nanowires with the organic active layer solution embeds the nanowires directly within active layers of the solar cell. The ability of these nanowires to transport electrons is compared with neat P3HT:PCBM active layers and also devices containing TiO2 nanotube aggregates. Incorporation of TiO2 nanowires yields a six-fold increase in the electron mobility relative to unmodified devices, leading to a 19% improvement in the power conversion efficiency. Lower energetic disorder of the film and more balanced charge transport are also observed upon incorporating TiO2 nanowires. These advantageous effects correlate with the TiO2 nanowire length.

Synthesis of Arylamine Tribenzopentaphenes and Investigation of their Hole Mobility.

We report the versatile synthesis of two tribenzo[fj,ij,rst]pentaphene (TBP) derivatives bearing two diarylamine substituents attached at the opposite ends of the aromatic core. Field effect transistor (FET) devices of the bis-diarylamine-TBP compounds were fabricated using spin coating under different concentrations, spin speed, and solvent conditions. Emission spectra and surface investigation by atomic force microscopy (AFM) reveal the formation of aggregates induced by the strong π-π stacking of the aromatic core leading to island features, and thus, unexpected low hole mobilities. The synthetic strategy we show herein, however, offers the possibility to decorate the TBP core structure with various charge-carrier peripheral groups and optimized alkyl chains, which should improve the crystalline property of their thin films upon deposition, leading consequently to a better hole transport mobility.

Controlling vertical morphology within the active layer of organic photovoltaics using poly(3-hexylthiophene) nanowires and phenyl-C61-butyric acid methyl ester.

In this study, we demonstrate how the vertical morphology of bulk heterojunction solar cells, with an active layer consisting of self-assembled poly(3-hexylthiophene) (P3HT) nanowires and phenyl-C(61)-butyric acid methyl ester (PCBM), can be beneficially influenced. Most device fabrication routes using similar materials employ an annealing step to influence active layer morphology, but this process can create an unfavorable phase migration where P3HT is driven toward the top of the active layer. In contrast, we demonstrate devices that exhibit an increase in relative fullerene concentration at the top of the active layer by introducing the donor phase as a solid nanowire in the active layer solution and altering the pre-spin drying time. X-ray photoelectron spectroscopy and conductive and photoconductive atomic force microscopy provide detailed images of how the surface of the active layer can be influenced; this is done by tracking the concentration and alignment of P3HT and PCBM domains. Using this new procedure, devices are made with power conversion efficiencies surpassing 2%. Additionally, we show that nanowires grown in the presence of the fullerene perform differently than those that are grown and mixed separately; exposure to the nanowire during self-assembly may allow the fullerene to coat nanowire surfaces and influence the photocurrent within the device.