The effect of service excellence training: Examining providers\u27 patient experience scores

Previous research and applied work has shown that communication-based training has the potential to impact important outcomes for healthcare organizations. Our institution developed and deployed Service Excellence, a communications-focused training, in our large academic cancer-focused healthcare system. In this study, we investigated whether patient experience improved for those with care providers who completed Service Excellence, as measured by Press Ganey Provider Experience surveys, and whether the effect of Service Excellence training depends on employee engagement. Results indicated that participating in Service Excellence training positively impacts perceptions of patient experience, and that the impact of the training is stronger for providers with low engagement as compared to providers with high engagement. Findings suggest that communications-based training can be an effective mitigation strategy to assist even those low engaged physicians with displaying the expected behaviors for positive patient interactions. Implications for healthcare organizations are discussed, including the rationale for motivating providers to attend such training. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Skyrmion fluctuations at a first-order phase transition boundary

Magnetic skyrmions are topologically protected spin textures with promising prospects for applications in data storage. They can form a lattice state due to competing magnetic interactions and are commonly found in a small region of the temperature - magnetic field phase diagram. Recent work has demonstrated that these magnetic quasi-particles fluctuate at the μeV energy scale. Here, we use a coherent x-ray correlation method at an x-ray free-electron laser to investigate these fluctuations in a magnetic phase coexistence region near a first-order transition boundary where fluctuations are not expected to play a major role. Surprisingly, we find that the relaxation of the intermediate scattering function at this transition differs significantly compared to that deep in the skyrmion lattice phase. The observation of a compressed exponential behavior suggests solid-like dynamics, often associated with jamming. We assign this behavior to disorder and the phase coexistence observed in a narrow field-window near the transition, which can cause fluctuations that lead to glassy behavior

Air pollution exposure during critical time periods in gestation and alterations in cord blood lymphocyte distribution: a cohort of livebirths

<p>Abstract</p> <p>Background</p> <p>Toxic exposures have been shown to influence maturation of the immune system during gestation. This study investigates the association between cord blood lymphocyte proportions and maternal exposure to air pollution during each gestational month.</p> <p>Methods</p> <p>Cord blood was analyzed using a FACSort flow cytometer to determine proportions of T lymphocytes (CD3⁺cells and their subsets, CD4⁺and CD8⁺), B lymphocytes (CD19⁺) and natural killer (NK) cells. Ambient air concentrations of 12 polycyclic aromatic hydrocarbons (PAH) and particulate matter < 2.5 micrometer in diameter (PM_2.5) were measured using fixed site monitors. Arithmetic means of these pollutants, calculated for each gestational month, were used as exposure metrics. Data on covariates were obtained from medical records and questionnaires. Multivariable linear regression models were fitted to estimate associations between monthly PAH or PM_2.5and cord blood lymphocytes, adjusting for year of birth and district of residence and, in further models, gestational season and number of prior live births.</p> <p>Results</p> <p>The adjusted models show significant associations between PAHs or PM_2.5during early gestation and increases in CD3⁺and CD4⁺lymphocytes percentages and decreases in CD19⁺and NK cell percentages in cord blood. In contrast, exposures during late gestation were associated with decreases in CD3⁺and CD4⁺fractions and increases in CD19⁺and NK cell fractions. There was no significant association between alterations in lymphocyte distribution and air pollution exposure during the mid gestation.</p> <p>Conclusions</p> <p>PAHs and PM_2.5in ambient air may influence fetal immune development via shifts in cord blood lymphocytes distributions. Associations appear to differ by exposure in early versus late gestation.</p

Removal of cell surface heparan sulfate increases TACE activity and cleavage of ErbB4 receptor

<p>Abstract</p> <p>Background</p> <p>Nuclear localization of proteolytically formed intracellular fragment of ErbB4 receptor tyrosine kinase has been shown to promote cell survival, and nuclear localization of ErbB4 receptor has been described in human breast cancer. Tumor necrosis factor alpha converting enzyme (TACE) initiates the proteolytic cascade leading to ErbB4 intracellular domain formation. Interactions between matrix metalloproteases and heparan sulfate have been described, but the effect of cell surface heparan sulfate on TACE activity has not been previously described.</p> <p>Results</p> <p>As indicated by immunodetection of increased ErbB4 intracellular domain formation and direct enzyme activity analysis, TACE activity was substantially amplified by enzymatic removal of cell surface heparan sulfate but not chondroitin sulfate.</p> <p>Conclusion</p> <p>In this communication, we suggest a novel role for cell surface heparan sulfate. Removal of cell surface heparan sulfate led to increased formation of ErbB4 intracellular domain. As ErbB4 intracellular domain has previously been shown to promote cell survival this finding may indicate a novel mechanism how HS degradation active in tumor tissue may favor cell survival.</p

Spontaneous fluctuations in a magnetic Fe/Gd skyrmion lattice

Magnetic skyrmions are topological spin textures that exhibit classical or quantum quasiparticle behavior. A substantial amount of research has occurred in this field, both because of their unique electromagnetic properties and potential application for future nonvolatile memory storage applications, as well as fundamental questions on their topology and unique magnetic phases. Here, we investigate the fluctuation properties of a magnetic Fe/Gd skyrmion lattice, using short-pulsed x rays. We first measure spontaneous fluctuations of the skyrmion lattice phase and find an inherent, collective mode showing an underdamped oscillation with a relaxation of a couple of nanoseconds. Further observations track the response towards the continuous phase transition and a critical-like slowing down of fluctuations is observed well before the critical point. These results suggest that the skyrmion lattice phase never fully freezes into a static crystal. This constant state of fluctuation indicates that the physics of topological magnetic phases may have more in common with high-temperature superconductors with disorder

Quality assurance/quality control summary report on phase 2 of the Clinch River remedial investigation at the Oak Ridge Reservation, Oak Ridge, Tennessee

Quality assurance (QA) objectives for Phase 2 were that (1) scientific data generated would withstand scientific and legal scrutiny; (2) data would be gathered using appropriate procedures for sample collection, sample handling and security, chain of custody, laboratory analyses, and data reporting; (3) data would be of known precision and accuracy; and (4) data would meet data quality objectives defined in the Phase 2 Sampling and Analysis Plan. A review of the QA systems and quality control (QC) data associated with the Phase 2 investigation is presented to evaluate whether the data were of sufficient quality to satisfy Phase 2 objectives. The data quality indicators of precision, accuracy, representativeness, comparability, completeness, and sensitivity were evaluated to determine any limitations associated with the data. Data were flagged with qualifiers that were associated with appropriate reason codes and documentation relating the qualifiers to the reviewer of the data. These qualifiers were then consolidated into an overall final qualifier to represent the quality of the data to the end user. In summary, reproducible, precise, and accurate measurements consistent with CRRI objectives and the limitations of the sampling and analytical procedures used were obtained for the data collected in support of the Phase 2 Remedial Investigation

Microstructured catalytic hollow fiber reactor for methane steam reforming

Microstructured alumina hollow fibers, which contain a plurality of radial microchannels with significant openings on the inner surface, have been fabricated in this study and used to develop an efficient catalytic hollow fiber reactor. Apart from low mass-transfer resistance, a unique structure of this type facilitates the incorporation of Ni-based catalysts, which can be with or without the aged secondary support, SBA-15. In contrast to a fixed bed reactor, the catalytic hollow fiber reactor shows similar methane conversion, with a gas hourly space velocity that is approximately 6.5 times higher, a significantly greater CO2 selectivity, and better productivity rates. These results demonstrate the advantages of dispersing the catalyst inside the microstructured hollow fiber as well as the potential to reduce the required quantity of catalyst