Future of Leadership in Healthcare: Enabling Complexity Dynamics Across Levels

Healthcare is one of the world\u27s fastest-growing industries with over $10 trillion in projected spending by 2022 (Deloitte, 2019). Despite this growth, the industry faces several challenges including rising costs, care delivery outside urban areas and to marginalized populations, digital transformation, and regulatory compliance. To navigate these challenges and capitalize on growth opportunities, leaders must build and manage complex dynamics occurring in the space between the organization and a wide range of internal and external stakeholders. In this symposium, we address this issue by assembling a group of scholars trained in healthcare management, strategy, leadership, and organizational theory to discuss the role of leaders in the future of healthcare. Through a series of presentations, we will illustrate how leaders in healthcare enable complexity dynamics across organizational levels to drive desired outcomes. In doing so, we bring to the forefront the multilevel and complex nature of healthcare leadership and invite innovative thinking about leadership for the future of healthcare. Building Extra-Organizational Adaptive Networks: Complexity Leadership in Healthcare Presenter: Erin Bass; U. of Nebraska, Omaha Presenter: Ivana Milosevic; College of Charleston Physician CEOs & Patient Safety Presenter: Geoffrey Silvera; Auburn U. Presenter: Timothy J. Vogus; Vanderbilt U. Presenter: Jonathan Clark; U. of Texas At San Antonio Management Practices of Under-Resourced Nursing Homes Presenter: Justin Lord; Louisiana State U. Shreveport Stitching Ties: Team Performance in the Connected Organization Presenter: John Hollingsworth; U. of Michigan Presenter: Jason Owen-Smith; U. of Michigan, Ann Arbor Presenter: Dennie Kim; U. of Virginia Darden School of Business Presenter: Marlon DeMarcie Twyman; U. of Southern California, Annenberg School for Communication and Journalism Identifying Healthcare\u27s Future Leaders: Development of a Leadership Potential Model for Healthcare Presenter: Kevin S. Groves; Pepperdine U. Presenter: Ann E. Feyerherm; Pepperdine Graziadio Business Schoo

AEGIS: Demographics of X-ray and Optically Selected AGNs

We develop a new diagnostic method to classify galaxies into AGN hosts, star-forming galaxies, and absorption-dominated galaxies by combining the [O III]/Hbeta ratio with rest-frame U-B color. This can be used to robustly select AGNs in galaxy samples at intermediate redshifts (z<1). We compare the result of this optical AGN selection with X-ray selection using a sample of 3150 galaxies with 0.3<z<0.8 and I_AB<22, selected from the DEEP2 Galaxy Redshift Survey and the All-wavelength Extended Groth Strip International Survey (AEGIS). Among the 146 X-ray sources in this sample, 58% are classified optically as emission-line AGNs, the rest as star-forming galaxies or absorption-dominated galaxies. The latter are also known as "X-ray bright, optically normal galaxies" (XBONGs). Analysis of the relationship between optical emission lines and X-ray properties shows that the completeness of optical AGN selection suffers from dependence on the star formation rate and the quality of observed spectra. It also shows that XBONGs do not appear to be a physically distinct population from other X-ray detected, emission-line AGNs. On the other hand, X-ray AGN selection also has strong bias. About 2/3 of all emission-line AGNs at L_bol>10^44 erg/s in our sample are not detected in our 200 ks Chandra images, most likely due to moderate or heavy absorption by gas near the AGN. The 2--7 keV detection rate of Seyfert 2s at z~0.6 suggests that their column density distribution and Compton-thick fraction are similar to that of local Seyferts. Multiple sample selection techniques are needed to obtain as complete a sample as possible.Comment: 24 pages, 14 figures, submitted to ApJ. Version 2 matches the ApJ accepted version. Sec 3 was reorganized and partly rewritten with one additional figure (Fig.3

Mapping dust through emission and absorption in nearby galaxies

Dust has long been identified as a barrier to measuring inherent galaxy properties. However, the link between dust and attenuation is not straightforward and depends on both the amount of dust and its distribution. Herschel imaging of nearby galaxies undertaken as part of the KINGFISH project allows us to map the dust as seen in emission with unprecedented sensitivity and similar to 1 kpc resolution. We present here new optical integral field unit spectroscopy for eight of these galaxies that provides complementary 100-200 pc scale maps of the dust attenuation through observation of the reddening in both the Balmer decrement and the stellar continuum. The stellar continuum reddening, which is systematically less than that observed in the Balmer decrement, shows no clear correlation with the dust, suggesting that the distribution of stellar reddening acts as a poor tracer of the overall dust content. The brightest H II regions are observed to be preferentially located in dusty regions, and we do find a correlation between the Balmer line reddening and the dust mass surface density for which we provide an empirical relation. Some of the high-inclination systems in our sample exhibit high extinction, but we also find evidence that unresolved variations in the dust distribution on scales smaller than 500 pc may contribute to the scatter in this relation. We caution against the use of integrated A(V) measures to infer global dust properties

A population of luminous accreting black holes with hidden mergers

Major galaxy mergers are thought to play an important part in fuelling the growth of supermassive black holes. However, observational support for this hypothesis is mixed, with some studies showing a correlation between merging galaxies and luminous quasars and others showing no such association. Recent observations have shown that a black hole is likely to become heavily obscured behind merger-driven gas and dust, even in the early stages of the merger, when the galaxies are well separated (5 to 40 kiloparsecs). Merger simulations further suggest that such obscuration and black-hole accretion peaks in the final merger stage, when the two galactic nuclei are closely separated (less than 3 kiloparsecs). Resolving this final stage requires a combination of high-spatial-resolution infrared imaging and high-sensitivity hard-X-ray observations to detect highly obscured sources. However, large numbers of obscured luminous accreting supermassive black holes have been recently detected nearby (distances below 250 megaparsecs) in X-ray observations. Here we report high-resolution infrared observations of hard-X-ray-selected black holes and the discovery of obscured nuclear mergers, the parent populations of supermassive-black-hole mergers. We find that obscured luminous black holes (bolometric luminosity higher than 2x10^44 ergs per second) show a significant (P<0.001) excess of late-stage nuclear mergers (17.6 per cent) compared to a sample of inactive galaxies with matching stellar masses and star formation rates (1.1 per cent), in agreement with theoretical predictions. Using hydrodynamic simulations, we confirm that the excess of nuclear mergers is indeed strongest for gas-rich major-merger hosts of obscured luminous black holes in this final stage.Comment: To appear in the 8 November 2018 issue of Nature. This is the authors' version of the wor

Imaging biomarker roadmap for cancer studies.

Imaging biomarkers (IBs) are integral to the routine management of patients with cancer. IBs used daily in oncology include clinical TNM stage, objective response and left ventricular ejection fraction. Other CT, MRI, PET and ultrasonography biomarkers are used extensively in cancer research and drug development. New IBs need to be established either as useful tools for testing research hypotheses in clinical trials and research studies, or as clinical decision-making tools for use in healthcare, by crossing 'translational gaps' through validation and qualification. Important differences exist between IBs and biospecimen-derived biomarkers and, therefore, the development of IBs requires a tailored 'roadmap'. Recognizing this need, Cancer Research UK (CRUK) and the European Organisation for Research and Treatment of Cancer (EORTC) assembled experts to review, debate and summarize the challenges of IB validation and qualification. This consensus group has produced 14 key recommendations for accelerating the clinical translation of IBs, which highlight the role of parallel (rather than sequential) tracks of technical (assay) validation, biological/clinical validation and assessment of cost-effectiveness; the need for IB standardization and accreditation systems; the need to continually revisit IB precision; an alternative framework for biological/clinical validation of IBs; and the essential requirements for multicentre studies to qualify IBs for clinical use.Development of this roadmap received support from Cancer Research UK and the Engineering and Physical Sciences Research Council (grant references A/15267, A/16463, A/16464, A/16465, A/16466 and A/18097), the EORTC Cancer Research Fund, and the Innovative Medicines Initiative Joint Undertaking (grant agreement number 115151), resources of which are composed of financial contribution from the European Union's Seventh Framework Programme (FP7/2007-2013) and European Federation of Pharmaceutical Industries and Associations (EFPIA) companies' in kind contribution

Imaging biomarker roadmap for cancer studies.

Imaging biomarkers (IBs) are integral to the routine management of patients with cancer. IBs used daily in oncology include clinical TNM stage, objective response and left ventricular ejection fraction. Other CT, MRI, PET and ultrasonography biomarkers are used extensively in cancer research and drug development. New IBs need to be established either as useful tools for testing research hypotheses in clinical trials and research studies, or as clinical decision-making tools for use in healthcare, by crossing 'translational gaps' through validation and qualification. Important differences exist between IBs and biospecimen-derived biomarkers and, therefore, the development of IBs requires a tailored 'roadmap'. Recognizing this need, Cancer Research UK (CRUK) and the European Organisation for Research and Treatment of Cancer (EORTC) assembled experts to review, debate and summarize the challenges of IB validation and qualification. This consensus group has produced 14 key recommendations for accelerating the clinical translation of IBs, which highlight the role of parallel (rather than sequential) tracks of technical (assay) validation, biological/clinical validation and assessment of cost-effectiveness; the need for IB standardization and accreditation systems; the need to continually revisit IB precision; an alternative framework for biological/clinical validation of IBs; and the essential requirements for multicentre studies to qualify IBs for clinical use.Development of this roadmap received support from Cancer Research UK and the Engineering and Physical Sciences Research Council (grant references A/15267, A/16463, A/16464, A/16465, A/16466 and A/18097), the EORTC Cancer Research Fund, and the Innovative Medicines Initiative Joint Undertaking (grant agreement number 115151), resources of which are composed of financial contribution from the European Union's Seventh Framework Programme (FP7/2007-2013) and European Federation of Pharmaceutical Industries and Associations (EFPIA) companies' in kind contribution