The Proximity Hotel: a case study on guest satisfaction of sustainable luxury environments

With sustainable luxury hotels only recently becoming a trend in the hospitality field, many hospitality professionals lack a clear understanding of how sustainability and luxury might fit together in the built-environment and how those decisions affect guest satisfaction. The Proximity Hotel is located in Greensboro, NC and is the first LEED Platinum hotel and restaurant within the United States. This hotel is the context for this case study. While the hotel has reduced its water and energy use drastically compared to other hotels of its size, it boasts that guests will not sacrifice a great luxury experience (Marano, 2008; Proximity Hotel, 2009). In hotels, style and comfort are two key factors that contribute to a luxury experience (Talbott, 2004); yet, sustainable design is often assumed to be unattractive in appearance and uncomfortable (McLennan, 2004; NEWH: The Hospitality Industry Network, 2007). The design, style, and comfort of a hotels built-environment affect guest selection of their hotel, their satisfaction, and their likelihood to revisit or recommend a hotel (Heide & GrØnhaug, 2009; Kasim, 2004; Ramsaran-Fowdar, 2007; Skogland & Siguaw, 2004). Values and attributes of luxury can be viewed as conflicting with the values and attributes of sustainable design; therefore, the primary focus of this study was to assess guest satisfaction with sustainable or luxury features of their rooms as well as their overall perceptions of the hotel. A guest survey was developed and 241 responses were collected and considered usable. Variables studied include sustainable and comfort features within the guestrooms and general guest satisfaction indicators related to luxury, comfort, style, experience, and overall satisfaction with the hotel. It is widely acknowledged that sustainable development includes many factors and principles. For purposes of this study the focus was limited primarily to the environmental aspects of sustainability. Guests desire to support environmentally conscious hotels, which was evident from the finding that almost half of the survey respondents indicated that their decision to stay at the hotel was influenced by the hotel's sustainable practices. Female guests consistently noted higher satisfaction levels with the room characteristics and the general satisfaction variables. Improved air quality, in-room recycling options, and abundant natural lighting were found to be sustainable features that contributed to a luxury experience, rather than detracting from one. Almost all of those surveyed said they would consider another stay at the hotel if they were visiting the same geographic area again. A satisfactory guest experience needs to be the first and most important consideration for hotels; however, it is also important for hotels to consider sustainable development and operational practices to reduce their ecological footprint. While sustainable design is perceived by some to be aesthetically unattractive and uncomfortable (McLennan, 2004; NEWH: The Hospitality Industry Network, 2007), guests indicated high satisfaction with the room and hotel design, room comfort, and with the overall luxury. The intersection of luxury and sustainability examined in this study indicates that, at least for the Proximity Hotel, that luxury and sustainable design within the context of a hotel environment do not conflict

Testing a Theory of Strategic Implementation Leadership, Implementation Climate, and Clinicians’ Use of Evidence-Based Practice: A 5-Year Panel Analysis

Background: Implementation theory suggests that first-level leaders, sometimes referred to as middle managers, can increase clinicians’ use of evidence-based practice (EBP) in healthcare settings by enacting specific leadership behaviors (i.e., proactive, knowledgeable, supportive, perseverant with regard to implementation) that develop an EBP implementation climate within the organization; however, longitudinal and quasi-experimental studies are needed to test this hypothesis. Methods: Using data collected at three waves over a 5-year period from a panel of 30 outpatient children’s mental health clinics employing 496 clinicians, we conducted a quasi-experimental difference-in-differences study to test whether within-organization change in implementation leadership predicted within-organization change in EBP implementation climate, and whether change in EBP implementation climate predicted within-organization change in clinicians’ use of EBP. At each wave, clinicians reported on their first-level leaders’ implementation leadership, their organization’s EBP implementation climate, and their use of both EBP and non-EBP psychotherapy techniques for childhood psychiatric disorders. Hypotheses were tested using econometric two-way fixed effects regression models at the organization level which controlled for all stable organizational characteristics, population trends in the outcomes over time, and time-varying covariates. Results: Organizations that improved from low to high levels of implementation leadership experienced significantly greater increases in their level of EBP implementation climate (d = .92, p = .017) and within-organization increases in implementation leadership accounted for 11% of the variance in improvement in EBP implementation climate beyond all other covariates. In turn, organizations that improved from low to high levels of EBP implementation climate experienced significantly greater increases in their clinicians’ average EBP use (d = .55, p = .007) and within-organization improvement in EBP implementation climate accounted for 14% of the variance in increased clinician EBP use. Mediation analyses indicated that improvement in implementation leadership had a significant indirect effect on clinicians’ EBP use via improvement in EBP implementation climate (d = .26, 95% CI [.02 to .59]). Conclusions: When first-level leaders increase their frequency of implementation leadership behaviors, organizational EBP implementation climate improves, which in turn contributes to increased EBP use by clinicians. Trials are needed to test strategies that target this implementation leadership–EBP implementation climate mechanism

Application of a Hybrid Statistical–Dynamical System to Seasonal Prediction of North American Temperature and Precipitation

Recent research demonstrates that dynamical models sometimes fail to represent observed teleconnection patterns associated with predictable modes of climate variability. As a result, model forecast skill may be reduced. We address this gap in skill through the application of a Bayesian postprocessing technique—the calibration, bridging, and merging (CBaM) method—which previously has been shown to improve probabilistic seasonal forecast skill over Australia. Calibration models developed from dynamical model reforecasts and observations are employed to statistically correct dynamical model forecasts. Bridging models use dynamical model forecasts of relevant climate modes (e.g., ENSO) as predictors of remote temperature and precipitation. Bridging and calibration models are first developed separately using Bayesian joint probability modeling and then merged using Bayesian model averaging to yield an optimal forecast. We apply CBaM to seasonal forecasts of North American 2-m temperature and precipitation from the North American Multimodel Ensemble (NMME) hindcast. Bridging is done using the model-predicted Niño-3.4 index. Overall, the fully merged CBaM forecasts achieve higher Brier skill scores and better reliability compared to raw NMME forecasts. Bridging enhances forecast skill for individual NMME member model forecasts of temperature, but does not result in significant improvements in precipitation forecast skill, possibly because the models of the NMME better represent the ENSO–precipitation teleconnection pattern compared to the ENSO– temperature pattern. These results demonstrate the potential utility of the CBaM method to improve seasonal forecast skill over North America

Impact of hospital diagnosis-specific quality measures on patients’ experience of hospital care: Evidence from 14 states, 2009-2011

In order to assess consistency across quality measures for Untied States hospitals, this paper uses patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for three years (2009-2011) from 1,333 acute-care hospitals in fourteen states to analyze patterns in hospital-reported patient experience-of-care scores by diagnosis-specific process and outcome measures for acute myocardial infarction, heart failure, and pneumonia. We also evaluate how scores have changed over the three-year period. We find significant differences in patient experience-of-care scores for 195 out of 230 relationships between HCAHPS patient experience-of-care scores and 23 diagnosis-specific process and outcomes measures. We find nearly no significant differences in changes in scores from 2009-2011 (8 out of 230) when comparing the same experience-of-care and diagnosis-specific quality measures. For the majority of measures, high scores on the quality metrics were associated with high patient experience-of-care scores

Resolving the cofactor-binding site in the proline biosynthetic enzyme human pyrroline-5-carboxylate reductase 1

Pyrroline-5-carboxylate reductase (PYCR) is the final enzyme in proline biosynthesis, catalyzing the NAD(P)H-dependent reduction of [?]1-pyrroline-5-carboxylate (P5C) to proline. Mutations in the PYCR1 gene alter mitochondrial function and cause the connective tissue disorder cutis laxa. Furthermore, PYCR1 is overexpressed in multiple cancers, and the PYCR1 knock-out suppresses tumorigenic growth, suggesting that PYCR1 is a potential cancer target. However, inhibitor development has been stymied by limited mechanistic details for the enzyme, particularly in light of a previous crystallographic study that placed the cofactor-binding site in the C-terminal domain rather than the anticipated Rossmann fold of the N-terminal domain. To fill this gap, we report crystallographic, sedimentation- velocity, and kinetics data for human PYCR1. Structures of binary complexes of PYCR1 with NADPH or proline determined at 1.9 Å resolution provide insight into cofactor and substrate recognition.WeseeNADPHbound to the Rossmann fold, over 25 Å from the previously proposed site. The 1.85 Å resolution structure of a ternary complex containing NADPH and a P5C/proline analog provides a model of the Michaelis complex formed during hydride transfer. Sedimentation velocity shows that PYCR1 forms a concentration-dependent decamer in solution, consistent with the pentamer-of-dimers assembly seen crystallographically. Kinetic and mutational analysis confirmed several features seen in the crystal structure, including the importance of a hydrogen bond between Thr-238 and the substrate as well as limited cofactor discrimination

Impact of hospital characteristics on patients’ experience of hospital care: Evidence from 14 states, 2009-2011

This paper uses patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for three years (2009-2011) from 1,333 acute-care hospitals in fourteen states to analyze patterns in 10 hospital-reported patient experience-of-care scores by 29 characteristics classified as: patient characteristics, payer source, patient severity, hospital characteristics, hospital operations, and market characteristics. We also evaluate how scores have changed over the three-year period. We find significant differences in patient experience-of-care scores by hospital characteristics for 250 out of 290 HCAHPS-hospital characteristic combinations measured. We find fewer significant differences in changes in scores from 2009-2011 (135 out of 290), with hospitals categorized as high scoring also reporting consistently greater improvement. We conclude that patient experience-of-care scores vary by hospital characteristics, although improvements in scores show less variety by hospital categorization

Extensive Plasmid Library to Prepare Tau Protein Variants and Study Their Functional Biochemistry

Tau neurofibrillary tangles are key pathological features of Alzheimer’s disease and other tauopathies. Recombinant protein technology is vital for studying the structure and function of tau in physiology and aggregation in pathophysiology. However, open-source and well-characterized plasmids for efficiently expressing and purifying different tau variants are lacking. We generated 44 sequence-verified plasmids including those encoding full length (FL) tau-441, its four-repeat microtubule-binding (K18) fragment, and their respective selected familial pathological variants (N279K, V337M, P301L, C291R, and S356T). Moreover, plasmids for expressing single (C291A), double (C291A/C322A), and triple (C291A/C322A/I260C) cysteine-modified variants were generated to study alterations in cysteine content and locations. Furthermore, protocols for producing representative tau forms were developed. We produced and characterized the aggregation behavior of the triple cysteine-modified tau-K18, often used in real-time cell internalization and aggregation studies because it can be fluorescently labeled on a cysteine outside the microtubule-binding core. Similar to the wild type (WT), triple cysteine-modified tau-K18 aggregated by progressive β-sheet enrichment, albeit at a slower rate. On prolonged incubation, cysteine-modified K18 formed paired helical filaments similar to those in Alzheimer’s disease, sharing morphological phenotypes with WT tau-K18 filaments. Nonetheless, cysteine-modified tau-K18 filaments were significantly shorter (p = 0.002) and mostly wider than WT filaments, explainable by their different principal filament elongation pathways: vertical (end-to-end) and lateral growth for WT and cysteine-modified, respectively. Cysteine rearrangement may therefore induce filament polymorphism. Together, the plasmid library, the protein production methods, and the new insights into cysteine-dependent aggregation should facilitate further studies and the design of antiaggregation agents

Human Cancer Long Non-Coding RNA Transcriptomes

Once thought to be a part of the ‘dark matter’ of the genome, long non-coding RNAs (lncRNAs) are emerging as an integral functional component of the mammalian transcriptome. LncRNAs are a novel class of mRNA-like transcripts which, despite no known protein-coding potential, demonstrate a wide range of structural and functional roles in cellular biology. However, the magnitude of the contribution of lncRNA expression to normal human tissues and cancers has not been investigated in a comprehensive manner. In this study, we compiled 272 human serial analysis of gene expression (SAGE) libraries to delineate lncRNA transcription patterns across a broad spectrum of normal human tissues and cancers. Using a novel lncRNA discovery pipeline we parsed over 24 million SAGE tags and report lncRNA expression profiles across a panel of 26 different normal human tissues and 19 human cancers. Our findings show extensive, tissue-specific lncRNA expression in normal tissues and highly aberrant lncRNA expression in human cancers. Here, we present a first generation atlas for lncRNA profiling in cancer