The Association Between an Established Chief Experience Officer Role and Hospital Patient Experience Scores

The healthcare industry is currently reacting to multiple stakeholders demanding improvements to the patient experience. Some healthcare organizations are implementing new management structures, i.e., the role of Chief Experience Officer (CXO). This study statistically reviewed descriptors associated with hospitals that have and have not created and filled the role of CXO and, more importantly, measured the association between the CXO role and results of patients’ perceptions of their experience of care as measured by publicly reported Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) results. This study was conducted utilizing data gather on hospitals in three states, California, Florida, and New York. The results of the study yield insight into the organization characteristics of hospitals and the market factors associated with those hospitals that have filled the CXO role. Hospitals with a formal CXO role are larger, more likely to be for profit, and operate in metro areas of these states with higher per capita income. In addition, hospitals that have a formal CXO role are also more likely to have higher HCAHPS scores as determined by the patient recommendation question as well as the hospital overall rating question included in the HCAHPS survey

Evolutionary ecology of pipefish brooding structures:embryo survival and growth do not improve with a pouch

For animals that reproduce in water, many adaptations in life-history traits such as egg size, parental care, and behaviors that relate to embryo oxygenation are still poorly understood. In pipefishes, seahorses and seadragons, males care for the embryos either in some sort of brood pouch, or attached ventrally to the skin on their belly or tail. Typically, egg size is larger in the brood pouch group and it has been suggested that oxygen supplied via the pouch buffers the developing embryos against hypoxia and as such is an adaptation that has facilitated the evolution of larger eggs. Here, using four pipefish species, we tested whether the presence or absence of brood pouch relates to how male behavior, embryo size, and survival are affected by hypoxia, with normoxia as control. Two of our studied species Entelurus aequoreus and Nerophis ophidion (both having small eggs) have simple ventral attachment of eggs onto the male trunk, and the other two, Syngnathus typhle (large eggs) and S. rostellatus (small eggs), have fully enclosed brood pouches on the tail. Under hypoxia, all species showed lower embryo survival, while species with brood pouches suffered greater embryo mortality compared to pouchless species, irrespective of oxygen treatment. Behaviorally, species without pouches spent more time closer to the surface, possibly to improve oxygenation. Overall, we found no significant benefits of brood pouches in terms of embryo survival and size under hypoxia. Instead, our results suggest negative effects of large egg size, despite the protection of brood pouches

Progressive osseous heteroplasia: A case report with an unexpected trigger

Progressive osseous heteroplasia (POH) is a rare genetic disorder characterised by progressive heterotopic ossification (HO) within the skin and subcutaneous tissues. The condition is caused by heterozygous inactivating mutations of the GNAS gene and usually presents in infancy. We describe the case of a white male ex-preterm who was first referred because of subcutaneous calcium deposits along the right arm after extravasation of parenteral nutrition. As these lesions progressed, a skin biopsy was undertaken which revealed intramembranous ossification. Genetic testing revealed a constitutional, de novo, heterozygous, nonsense variant in the GNAS gene that has not previously been described, but which is consistent with patient's clinical diagnosis of POH. No endocrine abnormalities or other signs congruent with overlapping conditions were detected. To the best of our knowledge, this is the first case describing an inflammatory trigger in POH. Trials with intravenous bisphosphonate and glucocorticoid as well as with topical sodium thiosulphate were attempted without clinical improvement. Excision of the calcifications and physiotherapy seem to have provided a partial improvement on mobility of the elbow. This case widens the spectrum of phenotypes seen in GNAS mutation disorders and suggests that alternative anti-inflammatory treatments may be effective. Mutations in GNAS should be considered in cases of significant progressive calcium deposition after extravasation injury

A Far-UV Spectroscopic Analysis of the Central Star of the Planetary Nebula Longmore 1

We have performed a non-LTE spectroscopic analysis using far-UV and UV data of the central star of the planetary nebula K1-26 (Longmore 1), and found Teff = 120+/-10 kK, logg = 6.7 +0.3/-0.7, and y = 0.10. The temperature is significantly hotter than previous results based on optical line analyses, highlighting the importance of analyzing the spectra of such hot objects at shorter wavelengths. The spectra show metal lines (from, e.g, carbon, oxygen, sulfur, and iron). The signatures of most elements can be fit adequately using solar abundances, confirming the classification of Longmore 1 as a high gravity O(H) object. Adopting a distance of 800 pc, we derive R = 0.04 Rsun, L = 250 Lsun, and M = 0.6 Msun. This places the object on the white dwarf cooling sequence of the evolutionary tracks with an age of ~= 65 kyr.Comment: 14 pages, 4 color figures. Accepted for publication in PAS

Central Stars of Planetary Nebulae in the Large Magellanic Cloud: A Far-UV Spectroscopic Analysis

We observed seven central stars of planetary nebulae (CSPN) in the Large Magellanic Cloud (LMC) with the Far Ultraviolet Spectroscopic Explorer (FUSE), and performed a model-based analysis of these spectra in conjunction with Hubble Space Telescope (HST) spectra in the UV and optical range to determine the stellar and nebular parameters. Most of the objects show wind features, and they have effective temperatures ranging from 38 to 60 kK with mass-loss rates of ~= 5x10^-8 Msun/yr. Five of the objects have typical LMC abundances. One object (SMP LMC 61) is a [WC4] star, and we fit its spectra with He/C/O-rich abundances typical of the [WC] class, and find its atmosphere to be iron-deficient. Most objects have very hot (T ~> 2000 K) molecular hydrogen in their nebulae, which may indicate a shocked environment. One of these (SMP LMC 62) also displays OVI 1032-38 nebular emission lines, rarely observed in PN.Comment: 53 pages, 15 figures (11 color). Accepted for publication in Ap

Far-UV Spectroscopic Analyses of Four Central Stars of Planetary Nebulae

We analyze the Far-UV/UV spectra of four central stars of planetary nebulae with strong wind features -- NGC 2371, Abell 78, IC 4776 and NGC 1535, and derive their photospheric and wind parameters by modeling high-resolution FUSE (Far-Ultraviolet Spectroscopic Explorer) data in the Far-UV and HST-STIS and IUE data in the UV with spherical non-LTE line-blanketed model atmospheres. Abell 78 is a hydrogen-deficient transitional [WR]-PG 1159 object, and we find NGC 2371 to be in the same stage, both migrating from the constant-luminosity phase to the white dwarf cooling sequence with Teff ~= 120 kK, Mdot ~= 5x10^-8 Msun/yr. NGC 1535 is a ``hydrogen-rich'' O(H) CSPN, and the exact nature of IC 4776 is ambiguous, although it appears to be helium burning. Both objects lie on the constant-luminosity branch of post-AGB evolution and have Teff ~= 65 kK, Mdot ~= 1x10^-8 Msun/yr. Thus, both the H-rich and H-deficient channels of PN evolution are represented in our sample. We also investigate the effects of including higher ionization stages of iron (up to FeX) in the model atmosphere calculations of these hot objects (usually neglected in previous analyses), and find iron to be a useful diagnostic of the stellar parameters in some cases. The Far-UV spectra of all four objects show evidence of hot (T ~ 300 K) molecular hydrogen in their circumstellar environments.Comment: 38 pages, 8 figures (6 color). Accepted for publication in Ap

The Rachel Carson Letters and the Making of Silent Spring

Environment, conservation, green, and kindred movements look back to Rachel Carson’s 1962 book Silent Spring as a milestone. The impact of the book, including on government, industry, and civil society, was immediate and substantial, and has been extensively described; however, the provenance of the book has been less thoroughly examined. Using Carson’s personal correspondence, this paper reveals that the primary source for Carson’s book was the extensive evidence and contacts compiled by two biodynamic farmers, Marjorie Spock and Mary T. Richards, of Long Island, New York. Their evidence was compiled for a suite of legal actions (1957-1960) against the U.S. Government and that contested the aerial spraying of dichlorodiphenyltrichloroethane (DDT). During Rudolf Steiner’s lifetime, Spock and Richards both studied at Steiner’s Goetheanum, the headquarters of Anthroposophy, located in Dornach, Switzerland. Spock and Richards were prominent U.S. anthroposophists, and established a biodynamic farm under the tutelage of the leading biodynamics exponent of the time, Dr. Ehrenfried Pfeiffer. When their property was under threat from a government program of DDT spraying, they brought their case, eventually lost it, in the process spent US$100,000, and compiled the evidence that they then shared with Carson, who used it, and their extensive contacts and the trial transcripts, as the primary input for Silent Spring. Carson attributed to Spock, Richards, and Pfeiffer, no credit whatsoever in her book. As a consequence, the organics movement has not received the recognition, that is its due, as the primary impulse for Silent Spring, and it is, itself, unaware of this provenance