The growth of new blood vessels from the pre-existing vasculature known as angiogenesis has a vital role in various physiological and pathological processes. In the present study, we demonstrate the pro-angiogenic properties of functional nanoconjugates of organosilane functionalized cerium oxide (CeO₂) nanoparticles (nanoceria). Aqueous dispersible CeO₂ and trivalent metal (samarium) ion-doped CeO₂ (SmCeO₂) nanoparticles conjugated with hydrophilic biocompatible and antifouling (6-{2-[2-(2-methoxy-ethoxy)-ethoxy]-ethoxy}-hexyl)triethoxysilane moieties were prepared. These functional nanoconjugates were prepared via an in situ synthesis and functionalization procedure using an ammonia-induced ethylene glycol-assisted precipitation method. The prepared nanoconjugates were thoroughly characterized using various physico-chemical techniques such as transmission electron microscopy (TEM), X-ray diffraction (XRD) analysis, dynamic light scattering (DLS), Fourier-transform infrared (FTIR) spectroscopy, ¹³C high-resolution solid-state nuclear magnetic resonance (NMR) spectroscopy, and X-ray photoelectron spectroscopy (XPS). The pro-angiogenic properties of the prepared nanoconjugates were evaluated by employing various angiogenesis assays (in vitro and in vivo). The results of the present study illustrate that the functional nanoconjugates of SmCeO₂ triggered endothelial cell proliferation and induced the growth of blood vessels in a chick embryo. The enhanced expression of pro-angiogenic markers (p38 MAPK/HIF-1α) by these functional nanoconjugates might be a plausible signaling mechanism underlying their pro-angiogenic properties. Considering all the observations, we believe that (6-{2-[2-(2-methoxy-ethoxy)-ethoxy]-ethoxy}-hexyl)triethoxysilane conjugated SmCeO₂ nanoparticles could be developed as potential candidates for the treatment of cardiovascular, ischemic and ocular diseases where angiogenesis is the principal phenomenon.

The number of people in the United States living with Alzheimer disease (AD) is growing, resulting in significant clinical and economic impact. Substantial research investment has led to drug development in stages of AD before symptomatic dementia, such as preclinical AD. Although there are no treatments approved for preclinical AD, there are currently 6 phase 3 clinical trials for preclinical AD treatments. In this article, we review these clinical trials and highlight considerations for future coverage decisions. In line with the definition of preclinical AD, enrollment in these trials focuses on cognitively unimpaired patients that are at high risk of AD because of family history and then genetic testing or brain imaging. Enrollment in most of these trials also allows for younger patients, including those aged under 65 years. Primary clinical trial endpoints focus on cognition often 4 or more years after treatment. Secondary endpoints include other measures of cognition and function, as well as biomarkers. Review of these trials brings to light a few potential considerations when covering these new medications in the future. First, novel and potentially costly approaches involving genetic testing and/or positron emission tomography imaging may be needed to identify appropriate patients and should be developed efficiently. Second, the long duration of these clinical trials suggest that there may be a need for alternative payment approaches in the United States that encourage early payers to pay for a medication for which the long-term benefits may not be realized until after the beneficiary is no longer with the health plan. Third, the value of AD treatments may differ across populations, creating a potential role for indication-based or population-based contracting. Finally, considering the potentially high budgetary impact and little real-world evidence for a new drug class, payers and manufacturers may want to consider outcomes-based payment approaches and coverage with evidence development to mitigate uncertainty about the value of the treatment demonstrated in well-defined populations in clinical trials versus more heterogeneous real-world settings. DISCLOSURES: This work was funded through a generous gift from the Global CEO Initiative on Alzheimer Disease. Hung reports grants from Agency for Healthcare Research and Quality and Pharmaceutical Research and Manufacturers of America outside the submitted work and past employment at CVS Health and BlueCross BlueShield Association. McClellan is an independent board member on the boards of Johnson & Johnson, Cigna, Alignment Healthcare, and Seer; co-chairs the Accountable Care Learning Collaborative and the Guiding Committee for the Health Care Payment Learning and Action Network; and receives fees for serving as an advisor for Cota and MITRE. Hamilton Lopez and Schneider have nothing to disclose. Part of this work was presented at the 2019 AMCP Nexus Meeting, October 29-November 1, 2019, in National Harbor, MD.

The effect of fully deacetylated chitosan (FDCH) edible coating combined with kojic acid (KA) and clove essential oil (CEO) as natural preservatives was investigated on the shelf-life of white prawn shrimp (Litopenaeus vannamei) during 15 days at cold storage. The results indicated that FDCH₁:KA_0.25:CEO_0.25 coating significantly inhibited the increase in total aerobic plate count, total volatile basic nitrogen content and pH of shrimp in comparison with the control. Moreover, compared with the control, the changes of total colour difference (ΔE values) and melanosis were significantly retarded, and the texture parameters and sensory scores were significantly improved in shrimp treated by FDCH₁:KA_0.25:CEO_0.25, suggesting that there is a synergistic effect between FDCH, KA, and CEO. In addition, a significant (P < 0.05) reduction in weight loss was observed for coated shrimp during the storage. The results suggested that FDCH₁:KA_0.25:CEO_0.25 coating may be promising to be used as active packaging for extending the shelf life, and incorporation of KA and CEO may enhance the efficacy of the coating.

Keywords: Clove essential oil; Fully deacetylated chitosan; Kojic acid.

Cinnamomum zeylanicum essential oil (CEO) is an effective antimicrobial agent. However, its high volatile nature and low stability require an efficient encapsulation system for drug delivery applications. We herein report the synthesis of β-cyclodextrin modified chitosan (β-CD/CS) nanoparticles binary system via ionic gelation method for the controlled release of CEO. The nanoparticles were characterized by optical and structural spectroscopies followed by the in-vitro released study. The results showed that the particles are spherical in shape with positively charged surface and maximum encapsulation efficiency of 58.03%. In vitro release profiles showed an overall CEO release of 71% for the binary system compared to 49% for CEO- loaded chitosan (CS) nanoparticles single system. The release mechanism followed Fickian behaviour while in vitro CEO release analysis showed a sustained and controlled release for over 120 h. The as-synthesized β-cyclodextrin/chitosan nanoparticles offer a promising system for enhancing the therapeutic effect of CEO.

Radioresistance is an important challenge for clinical treatments. The main causes of radioresistance include hypoxia in the tumor microenvironment, the antioxidant system within cancer cells, and the upregulation of DNA repair proteins. Here, a multiple radiosensitization strategy of high-Z-element-based radiation enhancement is designed, attenuating hypoxia and microRNA therapy. The novel 2D graphdiyne (GDY) can firmly anchor and disperse CeO₂ nanoparticles to form GDY-CeO₂ nanocomposites, which exhibit superior catalase-mimic activity in decomposing H₂ O₂ to O₂ to significantly alleviate tumor hypoxia, promote radiation-induced DNA damage, and ultimately inhibit tumor growth in vivo. The miR181a-2-3p (miR181a) serum levels in patients are predictive of the response to preoperative radiotherapy in locally advanced esophageal squamous cell carcinoma (ESCC) and facilitate personalized treatment. Moreover, miR181a can act as a radiosensitizer by directly targeting RAD17 and regulating the Chk2 pathway. Subsequently, the GDY-CeO₂ nanocomposites with miR181a are conjugated with the iRGD-grafted polyoxyethylene glycol (short for nano-miR181a), which can increase the stability, efficiently deliver miR181a to tumor, and exhibit low toxicity. Notably, nano-miR181a can overcome radioresistance and enhance therapeutic efficacy both in a subcutaneous tumor model and human-patient-derived xenograft models. Overall, this GDY-CeO₂ nanozyme and miR181a-based multisensitized radiotherapy strategy provides a promising therapeutic approach for ESCC.

<strong class="sub-title"> Keywords: </strong> GDY-<em>CeO</em>2 nanozymes; human sophageal squamous cell carcinoma; hypoxia alleviation; miR-181a-2-3p; radiosensitizers.

This study contemplates the effectiveness of the cognitive CEO on corporate environmental performance for the 1058 listed Chinese firms on Shenzhen and Shanghai stock exchanges for the years 2015-2019. The contributive concept of the cognitive CEO has been demonstrated through CEO tenure, education, goodwill, and attainment of tacit knowledge while implementing the DAE statistical technique. Additionally, the corporate environmental performance has been formulated, signifying the eight environmental attributes. Convincingly, innovation is intertwined with corporate environmental responsibility, which has been analyzed as a mediator. Remarkably, our findings envisage the cognitive CEO as a promoter of corporate environmental responsibility. Meanwhile, under the patronage of the cognitive CEO, innovation output has been ascertained as a vigorous intensifier of corporate environmental performance as compared with innovation input. Moreover, firms exhibiting specific characteristics like firm age, presence of independent directors, and being a state-owned enterprise proclaim their orientation towards corporate environmental responsibility. Specifically, under the patronage of stakeholder theory, empirical results have been interpreted. Significantly, the integrity of empirical results has been authenticated via the execution of GMM instrumental regression. Lastly, the implication of the study recommends the mangers, academicians, and organizational theorists to perceive the significance of cognitive CEO who can manage the funds for both innovation and corporate environmental responsibility.

Keywords: Chinese firms; Cognitive CEO; Corporate environmental performance; Innovation input; Innovation output.

A novel equilibrium strategy for measuring the hydrogen atom affinity of colloidal metal oxide nanoparticles is presented. Reactions between oleate-capped cerium oxide nanoparticle colloids (nanoceria) and organic proton-coupled electron transfer (PCET) reagents are used as a model system. Nanoceria redox changes, or hydrogen loadings, and overall reaction stoichiometries were followed by both ¹H NMR and X-ray absorption near-edge spectroscopies. These investigations revealed that, in many cases, reactions between nanoceria and PCET reagents reach equilibrium states with good mass balance. Each equilibrium state is a direct measure of the bond strength, or bond dissociation free energy (BDFE), between nanoceria and hydrogen. Further studies, including those with larger nanoceria, indicated that the relevant bond is a surface O-H. Thus, we have measured surface O-H BDFEs for nanoceria-the first experimental BDFEs for any nanoscale metal oxide. Remarkably, the measured CeO-H BDFEs span 13 kcal mol^-1 (0.56 eV) with changes in the average redox state of the nanoceria colloid. Possible chemical models for this strong dependence are discussed. We propose that the tunability of ceria BDFEs may be important in explaining its effectiveness in catalysis. More generally, metal oxide BDFEs have been used as predictors of catalyst efficacy that, traditionally, have only been accessible by computational methods. These results provide important experimental benchmarks for metal oxide BDFEs and demonstrate that the concepts of molecular bond strength thermochemistry can be applied to nanoscale materials.

UNASSIGNED

Empirical studies that explore whether hospitals with physician leadership perform better than hospitals led by nonphysician managers are scarce. This study looks at the leaders currently being hired by hospitals in the Arab World and explores whether chief executive officers (CEOs) in hospitals ranked higher are typically physician leaders or nonphysician managers. Furthermore, we discuss whether physicians, especially neurosurgeons, are equipped to lead hospitals and healthcare institutions worldwide.

UNASSIGNED

The "Ranking Web of World Hospitals" by Cybermetrics Lab, 2017, was used. A dataset on CEOs in the top 50 hospitals and the bottom 50 hospitals in the Arab World was constructed. Independent samples t-test and regression equations were conducted, and P values <0.05 were considered statistically significant.

UNASSIGNED

A total of 283 hospitals were ranked. Among the top 50 hospitals, 54% of the CEOs were physicians, whereas the remaining were nonphysician managers. Among the bottom 50 hospitals, 74% of the CEOs were physicians, whereas 26% of the CEOs were nonphysicians. Interestingly, physician leadership was significantly associated with lower hospital ranking (bottom 50 hospitals) in the Arab World (P = 0.0031).

UNASSIGNED

This article does not establish that nonphysician managers make more effective leaders when compared with physicians, but it starts an empirical course. For better evaluation of hospital leadership qualities, a new hospital ranking system must be created that focuses on patient satisfaction and perception of quality. Physician leaders, especially academic neurosurgeons, are an extraordinary leadership source, combining sound management with high medical standards. With the right academic training, neurosurgeons can play an increasingly significant role in addressing the challenges facing healthcare today.

Photodynamic therapy (PDT) and photothermal therapies (PTTs) are both promising strategies for effective tumor therapy. However, the absence of O₂ at tumor sites hinders the sustained response of photosensitizers. Here, we develop a recycled cerium oxide (CeO₂) catalase nanozyme-loaded hyaluronic acid nanovesicle to address the hypoxic tumor microenvironments and targeted delivery of the photosensitizers [indocyanine green (ICG)] to tumors. A polysaccharide complex effectively modifies the surface of a polyethylenimine phenylboronic acid nanostructure to achieve the CeO₂ nanozyme-loading nanovesicles that exhibit both tumor-targeted enhancement and an improved hypoxic microenvironment. Also, the hydrogen peroxide responsiveness and acid-sensitive cleavage of phenylboronic acid specifically disintegrate the ICG/nanozyme coloaded nanovesicles in the tumor microenvironment. The in vitro synergistic tests and tumor suppression rate tests indicated that the cerium oxide nanozyme significantly improves the outcomes of PDT via cerium-element valence state recycling and hypoxia improvement, thus enhancing the tumor suppression efficiency. This pH/H₂O₂-responsive nanozyme/ICG codelivery system provides a good carrier model for improving the tumor microenvironment and increasing the efficiency of tumor-targeted PTT and PDT therapies.

Keywords: cerium oxide; microenvironment response; nanozyme-ICG codelivery; photodynamic therapy; photothermal therapies; regenerable catalase nanozyme.

Effective activation of CO₂ is a prerequisite for efficient utilization of CO₂ in organic synthesis. Precisely controlling the interfacial events of solids shows potential for activation. Herein, defect-enriched CeO₂ with constructed interfacial frustrated Lewis pairs (FLPs, two adjacent Ce³⁺···O^2-) effectively activates CO₂ via the interactions between C/Lewis basic lattice O^2- and the two O atoms in CO₂/two adjacent Lewis acidic Ce³⁺ ions. Selective cyclic carbonate production from a catalytically tandem protocol of olefins and CO₂ is used to demonstrate FLP-inspired CO₂ activation.

Prior studies showed nanoparticle clearance was different in C57BL/6 versus BALB/c mice, strains prone to Th1 and Th2 immune responses, respectively. Objective: Assess nanoceria (cerium oxide, CeO₂ nanoparticle) uptake time course and organ distribution, cellular and oxidative stress, and bioprocessing as a function of mouse strain. Methods: C57BL/6 and BALB/c female mice were i.p. injected with 10 mg/kg nanoceria or vehicle and terminated 0.5 to 24 h later. Organs were collected for cerium analysis; light and electron microscopy with elemental mapping; and protein carbonyl, IL-1β, and caspase-1 determination. Results: Peripheral organ cerium significantly increased, generally more in C57BL/6 mice. Caspase-1 was significantly elevated in the liver at 6 h, to a greater extent in BALB/c mice, suggesting inflammasome pathway activation. Light microscopy revealed greater liver vacuolation in C57BL/6 mice and a nanoceria-induced decrease in BALB/c but not C57BL/6 mice vacuolation. Nanoceria increased spleen lymphoid white pulp cell density in BALB/c but not C57BL/6 mice. Electron microscopy showed intracellular nanoceria particles bioprocessed to form crystalline cerium phosphate nanoneedles. Ferritin accumulation was greatly increased proximal to the nanoceria, forming core-shell-like structures in C57BL/6 but even distribution in BALB/c mice. Conclusions: BALB/c mice were more responsive to nanoceria-induced effects, e.g. liver caspase-1 activation, reduced liver vacuolation, and increased spleen cell density. Nanoceria uptake, initiation of bioprocessing, and crystalline cerium phosphate nanoneedle formation were rapid. Ferritin greatly increased with a macrophage phenotype-dependent distribution. Further study will be needed to understand the mechanisms underlying the observed differences.

Keywords: BALB/c mice; C57BL/6 mice; caspase-1; ferritin; liver; nanoceria.

The International Children's Palliative Care Network (ICPCN) held its first international conference on children's palliative care, in conjunction with Tata Memorial Centre, in Mumbai, India, from 10-12 February 2014. The theme of the conference, Transforming children's palliative care-from ideas to action, reflected the vision of the ICPCN to live in a world where every child who needs it, can access palliative care, regardless of where they live. Key to this is action, to develop service provision and advocate for children's palliative care. Three pre-conference workshops were held on 9 February, aimed at doctors, nurses, social workers, and volunteers, and focused around the principles of children's palliative care, and in particular pain and symptom management. The conference brought together 235 participants representing 38 countries. Key themes identified throughout the conference included: the need for advocacy and leadership; for education and research, with great strides having been taken in the development of an evidence base for children's palliative care, along with the provision of education; the importance of communication and attention to spirituality in children, and issues around clinical care, in particular for neonates. Delegates were continually challenged to transform children's palliative care in their parts of the world and the conference culminated in the signing of the ICPCN Mumbai Declaration. The Declaration calls upon governments around the world to improve access to quality children's palliative care services and made a call on the Belgian government not to pass a bill allowing children to be euthanised in that country. The conference highlighted many of the ongoing developments in children's palliative care around the world, and as she closed the conference, Joan Marston (ICPCN CEO) challenged participants to take positive action and be the champions that the children need, thus transforming children's palliative care.

An innovative approach in the functionalization of nanofibers (NFs) for wound healing relies on non-antibiotic combinational therapy to subdue microbial invasion while reducing antimicrobial resistance and enhancing healing. Despite great potentials, wound healing efficacy of NFs embedding antimicrobial metal nanoparticles (NPs)/essential oils has been scarcely documented. We developed combinational NFs using an electrospinnable hyaluronic acid/polyvinyl alcohol/polyethylene oxide blend embedding a new ZnO NPs/cinnamon essential oil (CEO) antimicrobial combination. Fourier transform infrared, X-ray diffraction and transmission electron microscopy confirmed the presence of HA and distribution of ZnO NPs and CEO within NFs. Results for mean diameter, thermal stability, hydrophilicity, tensile strength, in vitro biodegradability, and cytocompatibility of crosslinked combinational NFs were intermediate between those of their singly loaded counterparts. All NFs inhibited the growth of Staphylococcus aureus (S. aureus). Compared with singly loaded NFs, combinational NFs showed the greatest healing efficacy of full thickness S. aureus inoculated incision wounds in rats in terms of bacterial inhibition following a single application, healing speed, and quality of skin structure recovery as verified by morphological, microbiological, and histopathological studies. Results highlighted the potentials of metal NPs/essential oil functionalization of nanofibrous wound dressings as an emerging antibiotic-free combinational approach for more effective and safer wound healing.

Keywords: Cinnamon oil; Hyaluronic acid; Nanofibers; Wound healing; Zinc oxide.

The aim of this study was to introduce Pickering emulsions stabilized by chitosan (CS)-stearic acid (SA) nanogels incoporating clove essential oil (CEO) as a new way to enrich mayonnaise with fish oil. Firstly, fish oil-in-water Pickering emulsion was prepared, which the most stability of emulsion was achived at 2 % (w/w) CS-SA nanogels and 60 % (w/w) fish oil. Then, the fish oil-in-water Pickering emulsions stabilized with 2 % CS-SA nanogels as well as 2 % CS-SA nanogels incorporating CEO were used in formulation of mayonnaise. The results showed that the use of fish oil in the form of emulsion stabilized with CS-SA nanogels increased the oxidative stability of mayonnaise. Moreover, rheological studies indicated that the use of CS-SA nanogels could increase the elasticity of mayonnaise, which higher elasticity was observed about mayonnaise containing CS-SA nanogels incorporating CEO. Overall, CS-SA nanogels incorporating CEO can be used for increasing gel-like structure of the fish-oil-enriched mayonnaise.

Keywords: Ammonium thiocyanate (PubChem CID: 15666); Chitosan-stearic acid nanogel; Clove essentioal oil; Cumene hydroperoxide (PubChem CID: 6629); Fish oil; Fluorescein isothiocyanate (FITC) (PubChem CID: 18730); Mayonnaise; Nile red (PubChem CID: 65182); Oxidative stability; Pickering emulsion; Rheological properties; Stearic acid (PubChem CID: 5281).

Traumatic brain injury (TBI) is a sudden injury to the brain, accompanied by the production of large amounts of reactive oxygen and nitrogen species (RONS) and acute neuroinflammation responses. Although traditional pharmacotherapy can effectively decrease the immune response of neuron cells via scavenging free radicals, it always involves in short reaction time as well as rigorous clinical trial. Therefore, a noninvasive topical treatment method that effectively eliminates free radicals still needs further investigation. Methods: In this study, a type of catalytic patch based on nanozymes with the excellent multienzyme-like activity is designed for noninvasive treatment of TBI. The enzyme-like activity, free radical scavenging ability and therapeutic efficacy of the designed catalytic patch were assessed in vitro and in vivo. The structural composition was characterized by the X-ray diffraction, X-ray photoelectron spectroscopy and high-resolution transmission electron microscopy technology. Results: Herein, the prepared Cr-doped CeO₂ (Cr/CeO₂) nanozyme increases the reduced Ce³⁺ states, resulting in its enzyme-like activity 3-5 times higher than undoped CeO₂. Furthermore, Cr/CeO₂ nanozyme can improve the survival rate of LPS induced neuron cells via decreasing excessive RONS. The in vivo experiments show the Cr/CeO₂ nanozyme can promote wound healing and reduce neuroinflammation of mice following brain trauma. The catalytic patch based on nanozyme provides a noninvasive topical treatment route for TBI as well as other traumas diseases. Conclusions: The catalytic patch based on nanozyme provides a noninvasive topical treatment route for TBI as well as other traumas diseases.

Keywords: RONS-scavenging; multienzyme-like activity; nanozyme; noninvasive treatment; traumatic brain injury.

Herein a clinical case of an unusual metastasis from breast cancer to the retina and vitreous confirmed by diagnostic vitrectomy is described. Further investigation also demonstrated the central nervous system metastasis.

Signalling the importance of healthcare quality and quality improvement plans in Ontario, the province's Excellent Care for all act requires all hospitals to publish quality improvement plans, conduct regular patient and staff surveys, and forge a clear link between hospital CEO compensation and quality improvement. The act also clarifies and strengthens links between evidence and quality of care. The act is an important step toward Ontario's becoming a high-performing healthcare system. Yet as some of the papers in this special issue of Healthcare Quarterly discuss, there remains much to be done. Other papers and interviews draw attention to the importance of strategic and system design levers--particularly setting goals, public reporting of results and clinician engagement--to stimulating improvement. Yet other papers present a diverse range of perspectives and ideas on how to pursue improvement and to bridge the knowing-doing gap in healthcare so that evidence informs better practice. Achieving and sustaining high performance in healthcare will require dedicated effort by everyone in every healthcare organization. With a view to the future, the act allows for the expansion of the quality obligations initially applicable to hospitals to other publicly funded health organizations.

BACKGROUND

Simulation is a powerful learning tool for building individual and team competencies of frontline health care providers with demonstrable impact on performance. This article examines the impact of simulation in building strategic leadership competencies for patient safety and quality among executive leaders in health care organizations.

METHODS

We designed, implemented, and evaluated a simulation as part of a larger safety leadership network meeting for executive leaders. This simulation targeted knowledge competencies of governance priority, culture of continuous improvement, and internal transparency and feedback. Eight teams of leaders in health care organizations-a total of 55 participants-participated in a 4-hour session. Each team performed collectively as a new chief executive officer (CEO) tasked with a goal of rescuing a hospital with a failing safety record. Teams worked on a modifiable simulation board reflecting the current dysfunctional organizational structure of the simulated hospital. They assessed and redesigned accountability structures based on information acquired in encounter sessions with confederates playing the role of internal staff and external consultants.

RESULTS

Data were analyzed, and results are presented as qualitative themes arising from the simulation exercise, participant reaction data, and performance during the simulation. Key findings include high degrees of variability in solutions developed for the dysfunctional hospital system and generally positive learner reactions to the simulation experience.

CONCLUSIONS

This study illustrates the potential value of simulation as a mechanism for learning and strategy development for executive leaders grappling with patient safety issues. Future research should explore the cognitive or functional fidelity of organizational simulations and the use of custom scenarios for strategic planning.

UNASSIGNED

Nurse managers (NMs) play an important role promoting evidence-based practice (EBP) on clinical units within hospitals. However, there is a dearth of research focused on NM perspectives about institutional contextual factors to support the goal of EBP on the clinical unit. The purpose of this article is to identify contextual factors described by NMs to drive change and facilitate EBP at the unit level, comparing and contrasting these perspectives across nursing units.

UNASSIGNED

This study employed a qualitative descriptive design using interviews with nine NMs who were participating in a large effectiveness study. To stratify the sample, NMs were selected from nursing units designated as high or low performing based on implementation of EBP interventions, scores on the Meyer and Goes research use scale, and fall rates. Descriptive content analysis was used to identify themes that reflect the complex nature of infrastructure described by NMs and contextual influences that supported or hindered their promotion of EBP on the clinical unit.

UNASSIGNED

NMs perceived workplace culture, structure, and resources as facilitators or barriers to empowering nurses under their supervision to use EBP and drive change. A workplace culture that provides clear communication of EBP goals or regulatory changes, direct contact with CEOs, and clear expectations supported NMs in their promotion of EBP on their units. High-performing unit NMs described a structure that included nursing-specific committees, allowing nurses to drive change and EBP from within the unit. NMs from high-performing units were more likely to articulate internal resources, such as quality-monitoring departments, as critical to the implementation of EBP on their units. This study contributes to a deeper understanding of institutional contextual factors that can be used to support NMs in their efforts to drive EBP changes at the unit level.

The use of nanoparticles (NPs) in numerous products and their potential accumulation causes major concern for humans and the environment. Until now, the uptake of NPs in plant tissue was mostly shown under greenhouse conditions at high doses and short exposure periods. Here, we present results on the uptake of particulate silver (Ag) and cerium dioxide (CeO₂) in the tissues of Triticum aestivum, Brassica napus, and Hordeum vulgare, after exposure to sewage sludge treated with nano-Ag (NM300 K at 1.8 and 7.0 mg/kg sludge per dm soil) and nano-CeO₂ (NM212 at 10 and 50 mg/kg sludge per dm soil). All plants were cultivated in a rural area near the German town Schmallenberg according to the common regional crop rotation on outdoor lysimeters. The highest concentrations measured were 86.4 mg/kg for Ag ( Hordeum vulgare) and 94 mg/kg for Ce ( Triticum sativum). Analysis of plant samples revealed the presence of Ag mainly in its ionic form. However, the occurrence of nano- and larger sized particles of Ag and CeO₂ was observed as well. Quantitative shares of the particulate fraction of the total element concentration were estimated up to 22.4% for Ag and up to 85.1% for CeO₂. A high abundance of particle agglomerates in the phloem suggests upward transport of the nanoparticles to other plant parts. A small number of agglomerates in the xylem suggests a downward transport and subsequent accumulation in the root phloem. Exemplary investigations of Brassica napus root exposed to nano-CeO₂ revealed no accumulation of the pristine material in the cell nucleus; however, CePO₄ was found_. The presence of this substance points to a dissolution of the low soluble CeO₂ in planta and subsequent precipitation. Furthermore, for the first time, mixed NP-salt agglomerates, composed of Ca₃PO₄⁺ and K₃SO₄⁺ NPs, could be observed within Brassica napus root tissue.

BACKGROUND

Previous strategic decision making research has focused mostly on the analytical positioning approach, which broadly emphasizes an alignment between rationality and the external environment. In this study, we propose that hospital chief executive optimism (or the general tendency to expect positive future outcomes) will moderate the relationship between comprehensively rational decision-making process and organizational performance.

OBJECTIVE

The purpose of this study was to explore the impact that dispositional optimism has on the well-established relationship between rational decision-making processes and organizational performance. Specifically, we hypothesized that optimism will moderate the relationship between the level of rationality and the organization's performance. We further suggest that this relationship will be more negative for those with high, as opposed to low, optimism.

METHODS

We surveyed 168 hospital CEOs and used moderated hierarchical regression methods to statically test our hypothesis.

RESULTS

On the basis of a survey study of 168 hospital CEOs, we found evidence of a complex interplay of optimism in the rationality-organizational performance relationship. More specifically, we found that the two-way interactions between optimism and rational decision making were negatively associated with performance and that where optimism was the highest, the rationality-performance relationship was the most negative. Executive optimism was positively associated with organizational performance. We also found that greater perceived environmental turbulence, when interacting with optimism, did not have a significant interaction effect on the rationality-performance relationship.

CONCLUSIONS

These findings suggest potential for broader participation in strategic processes and the use of organizational development techniques that assess executive disposition and traits for recruitment processes, because CEO optimism influences hospital-level processes. Research implications include incorporating greater use of behavior and cognition constructs to better depict decision-making processes in complex organizations like hospitals.

This paper uses observations from a panel data set of 35 chief executive officers (CEOs) from 29 not-for-profit hospitals in Connecticut over the period 1998 to 2006 to investigate the relationship between CEO performance and pay. Both economic and charity performance measures are specified in the empirical model. The multiple regression results reveal that not-for-profit hospital CEOs, at least in Connecticut, are driven at the margin to increase the occupancy rate of privately insured patients at the expense of uncompensated care and public-pay patients. This type of behavior on the part of not-for-profit hospital CEOs calls into question the desirability of allowing these hospitals a tax exemption on earned income, property, and purchases.