capturing the cosmos

Crashing neutron stars killed off some of our best ideas about ‘dark energy’

Cosmologists who were hoping to be the next Einstein have had to bin their theories.

There was much excitement when scientists witnessed the violent collision of two ultra-dense, massive stars more than 100m light years from the Earth earlier this year. Not only did they catch the resulting gravitational waves – ripples in the fabric of spacetime – they also saw a practically instantaneous flash of light. This is exciting in itself and was the first direct evidence for a merger of neutron stars.

But from a cosmologist’s perspective, the photo-finish of the gravitational waves and the flash of light has at a stroke demolished years of research into a completely unrelated problem: why is the expansion of the universe accelerating?

It turns out that space and time are actually mutable, pliable, flexible and wiggly, rather than constant, fixed or immovable. This has been known since Einstein published his theory of general relativity, which explains how gravity warps spacetime. The subtle effects that this mutability causes need to be accounted for even in the GPS that makes your sat nav and iPhone work.

One prediction of Einstein’s theory was that it should be possible for space-time to have waves in it, like the surface of the sea. These would be visible if one could, for example, smash together two black holes. This prediction was dramatically seen in the first detection of gravitational waves by the LIGO experiment in 2015. The discovery opened up a whole new way to probe the cosmos, and was awarded the Nobel Prize for physics.

The new detection of gravitational waves from the merger of neutron stars also has profound implications for our understanding of the universe. However for the cosmologists it was the flash of light 1.7 seconds after the gravitational waves that was the more intriguing observation.

The cosmic speed camera

The 1.7 second time delay is important because it means that the gravitational waves and the light waves had been travelling at almost exactly the same speed. In fact these are two of the most closely matched observed speeds ever: the two only differed by one part in 10m billion.

To put this into context if the speed cameras on the road could measure speed differences this finely you would get a ticket for going 30.0000000000000001mph in a 30mph zone.

Compared to the best measurements cosmologists were hoping for in the future this is a factor of a million billion times better. Factoring in that the electromagnetic waves may have taken a bit of time to escape from the turmoil of a neutron star collision, for all intents and purposes the speed difference is zero.

Cosmology is in a bit of a pickle. We have a great model that can explain the evolution of the universe from a fraction of a second after the big bang, until now approximately 14 billion years later. The problem is that in order to explain all the observations, a mysterious energy called “dark energy” must be added to the models. Dark energy is a huge problem, it accounts for about 70% of all the energy the universe, and we have absolutely no idea what it is.

Dark energy is like an anti-gravitational effect that is pushing the universe apart and causing its expansion to accelerate. So to explain dark energy, cosmologists have attempted to change or replace Einstein’s theory to see if a new theory of spacetime could finally explain the effects of dark energy.

One way that cosmologists tried to do this was by changing the speed in which gravitational waves and light travelled. There were many different theories that had this component – each with a peculiar name like quartic and quintic galileons, vector-tensor theories, generalised proca theories, bigravity theories and so forth. Without data any of the theories could have been correct, and there were many people hopeful that they could be the next Einstein or Newton.

Where are we now?

But now in a single observation from a single neutron star merger a wide variety of these have now been consigned to cosmological dustbin in a flurry of papers (here, here, here, here, here and here). So no new Einstein yet.

In the absence of compelling data, it is still possible that we can update Einstein so we can account for dark energy. But the wiggles from the gravitational wave data has left very little wriggle room.

Artist’s impression of the finished square kilometre array. Swinburne Astronomy Productions for SKA Project Development Office, CC BY-SA
Artist’s impression of the finished square kilometre array. Swinburne Astronomy Productions for SKA Project Development Office, CC BY-SA

All the theories that have survived the pruning are much simpler than those that were allowed before; and the simplest theory, and the frontrunner, is that dark energy is the energy of empty space, and just happens to have the value we observe.

Another explanation that has survived is that it’s a Higgs-like field. The now famous Higgs boson is a manifestation of a “Higgs field” – the first “scalar field” observed in nature. This is a field that has a value at every point in spacetime, but no direction. An analogy would be a pressure map on a weather forecast (values everywhere but no direction). A wind map, on the other hand, isn’t a scalar field as it has speed and overall direction. Apart from Higgs, all particles in nature are associated with “quantum fields” that aren’t scalar. But like the Higgs, dark energy could be an exception: a ubiquitous scalar field pushing the universe apart in every direction.

Thankfully we won’t have to wait long before new telescopes will test the remaining theories and a big piece of the cosmological puzzle will be completed.

Thomas Kitching, Reader in Astrophysics, UCL.

This article first appeared on The Conversation.

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What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

At the Emory University Hospital in Atlanta, visitors don’t have to worry about navigating their way across the complex hospital premises. All they need to do is download wayfinding tools from the installed digital signage onto their smartphone and get step by step directions. Other hospitals have digital signage in surgical waiting rooms that share surgery updates with the anxious families waiting outside, or offer general information to visitors in waiting rooms. Many others use digital registration tools to reduce check-in time or have Smart TVs in patient rooms that serve educational and anxiety alleviating content.

Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the Scroll.in marketing team and not by the Scroll.in editorial staff.