Exploring the Relationship Between Adventist Hospital Board Chair Leadership Behaviors and Effectiveness

Problem and Purpose. There is a lack of empirical research regarding the leadership behaviors that predict an effective community hospital board chair. Researchers indicate that an effective organization normally has a well-led board. However, the chair role has been largely neglected in the research of board functions and operations. With many hospitals facing reorganization or closing, it is important to understand and identify effective chair behaviors. Thus, the purpose of this study was to determine the relationship between hospital chair leadership behaviors and effectiveness, and the relationship of effective chairs to effective hospitals. Method. This study used an ex post facto research design with stated and alternative hypotheses. The study was based upon a repeated measures design where the board chairs’ effectiveness and behaviors were measured more than once. An online survey using the Multifactor Leadership Questionnaire (MLQ) was administered to 333 board members serving 34 Adventist Health System hospitals. This survey measured board member perceptions of chair leadership behaviors and chair effectiveness. Patient satisfaction and clinical and financial data were also collected from each hospital to measure hospital effectiveness. Descriptive statistics, correlation, and multiple regression models were used to describe and examine the statistical relationship between variables. Of the 55 hypotheses tested, 34 (62%) were statistically significant and three others approached statistical significance. Results and Conclusions. The chairs reviewed by respondents were all Caucasian and male, ranging from 38 to 68 years old with 70% being 51 to 66 years of age. They had college education, ranging from bachelor’s degrees to doctorates, with 67% having master’s degrees. The chair’s length of service at their current facility ranged from 7 months to 12.9 years, with 55% serving 5 to 6 years. With the p value set at .05, correlations and multiple regression analysis revealed the following: 1. There was statistical significance and a positive relationship between transformational leadership behaviors and chair effectiveness (r = .869; p =.000). 2. There was statistical significance and a positive relationship between transactional leadership behaviors and chair effectiveness (r =.382; p =.000). 3. There was no statistically significant relationship between laissez-faire leadership behaviors and chair effectiveness (r = -.122; p = .178). 4. There was statistical significance and a positive relationship between financial margin; Earnings Before Interest, Taxes, Depreciation, and Amortization (EBITDA) and Clinical Outcomes (CM) (r = .331; p = .000). There was no statistical significance in the relationship between hospital financial margins and patient satisfaction (r = .169; p = .066). 5. There was no statistical significance in the relationship found between chair leadership effectiveness and hospital effectiveness metrics such as EBITDA (r = -.019; p = .831), Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS; r = -160; p = .083), and CM (r = -.044; p = .632). 6. There was statistical significance and a positive relationship between chair education and chair effectiveness (r =.235; p = .009). 7. There was statistical significance and a positive relationship between chair education and the organizational metric EBITDA (r = .349; p = .000) but no statistically significant relationship between chair education and patient satisfaction (r = -.043; p = .643). 8. There was no statistically significant relationship between chair longevity and chair effectiveness (r = -.023; p = .803). 9. There was a statistically significant relationship between chair longevity and patient satisfaction as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS; r =.221; p = .016). However, there was statistical significance and a negative relationship between chair longevity and hospital financial success as measured by EBITDA (r = -.233; p = .010). 10. While nearing statistical significance, there was no statistically significant relationship between chair age and chair effectiveness (r = -.169; p = .061). 11. There was statistical significance and a negative relationship between chair age and hospital financial performance as measured by EBITDA (r = -203, p = .024). Conclusions and Recommendations. In this study, both transformational and transactional leadership behaviors predicted chair effectiveness. The relationship between Laissez-faire leadership behaviors and effectiveness was not statistically significant (r = -.122; p = .178). In addition, the study showed chair education had a statistically significant relationship on the hospitals’ financial margins (r = .349; p = .000). Finally, while strong financial margins predicted clinical outcomes (r = .331; p = .000), they did not have a statistically significant relationship to patient satisfaction (r = .169; p = .066). Several recommendations to boards, hospitals, and researchers can be made from this study. First, given the significance of transformational and transactional leadership behaviors on chair effectiveness, boards may wish to screen potential chairs for these behaviors or provide training that facilitates the development of these behaviors. Second, given the significance of chair education on chair effectiveness and hospital financial margins, boards may wish to screen chairs for higher levels of education to better predict chair and hospital effectiveness. Finally, given this study was done only on Adventist Health System hospitals and only White male chairs, other researchers may wish to replicate this study in other healthcare systems with more diverse chairs. In addition, initiating a qualitative study of chairs would provide additional answers to questions raised in this study

Understanding Board Leadership: Adventist Hospital Board Chair Behaviors and Effectiveness and Organizational Outcomes

Each month, millions of board members meet to provide leadership to thousands of churches, hospitals, schools and other nonprofit organizations. Their decisions impact tens of millions of jobs and billions of dollars of allocation. However, there is very limited research on the leadership provided to these boards. This article reviews data collected from 123 board members serving 34 Adventist Health System hospitals. It asked them to provide their perceptions of their chair\u27s leadership behaviors and effectiveness and compared that data to hospital outcome data in the form of patient satisfaction, clinical and financial data. Findings suggest that transformational behaviors and, to a lesser extent, transactional behaviors are central to members\u27 perceptions of chair leadership effectiveness. To the contrary, chair laissez-faire leadership behaviors were viewed as ineffective. In addition, those chairs with more education were perceived as more effective and a higher level of chair education was a predictor of larger financial margins. Findings also suggest that younger chairs are a predictor of financially sound hospitals

Optical Telescope Assembly Cost Estimating Model

Parametric cost models can be used by designers and project managers to compare cost between major architectural cost drivers and allow high-level design trades; enable cost-benefit analysis for technology development investment; and, provide a basis for estimating total project cost between related concepts. The NASA Marshall Space Flight Center has developed a 5- parameter cost model that explains 93% (Adjusted R2) of the cost variation in a database of 46 total ground and space telescope assemblies. This model can be used to estimate the most probably cost for the Habitable Exoplanet Telescope Assembly

Learning to play 3 x 3 games : neural networks as bounded-rational players

We present a neural network methodology for learning game-playing rules in general. Existing research suggests learning to find a Nash equilibrium in a new game is too difficult a task for a neural network, but says little about what it will do instead. We observe that a neural network trained to find Nash equilibria in a known subset of games, will use self-taught rules developed endogenously when facing new games. These rules are close to payoff dominance and its best response. Our findings are consistent with existing experimental results, both in terms of subject's methodology and success rates

OGFOD1 catalyzes prolyl hydroxylation of RPS23 and is involved in translation control and stress granule formation

2-Oxoglutarate (2OG) and Fe(II)-dependent oxygenase domain-containing protein 1 (OGFOD1) is predicted to be a conserved 2OG oxygenase, the catalytic domain of which is related to hypoxia-inducible factor prolyl hydroxylases. OGFOD1 homologs in yeast are implicated in diverse cellular functions ranging from oxygen-dependent regulation of sterol response genes (Ofd1, Schizosaccharomyces pombe) to translation termination/mRNA polyadenylation (Tpa1p, Saccharomyces cerevisiae). However, neither the biochemical activity of OGFOD1 nor the identity of its substrate has been defined. Here we show that OGFOD1 is a prolyl hydroxylase that catalyzes the posttranslational hydroxylation of a highly conserved residue (Pro-62) in the small ribosomal protein S23 (RPS23). Unusually OGFOD1 retained a high affinity for, and forms a stable complex with, the hydroxylated RPS23 substrate. Knockdown or inactivation of OGFOD1 caused a cell type-dependent induction of stress granules, translational arrest, and growth impairment in a manner complemented by wild-type but not inactive OGFOD1. The work identifies a human prolyl hydroxylase with a role in translational regulation

Meniscal T1rho and T2 measured with 3.0T MRI increases directly after running a marathon

PURPOSE: To prospectively evaluate changes in T1rho and T2 relaxation time in the meniscus using 3.0 T MRI in asymptomatic knees of marathon runners and to compare these findings with those of age-matched healthy subjects. MATERIAL AND METHODS: Thirteen marathon runners underwent 3.0 T MRI including T1rho and T2 mapping sequences before, 48-72 h after, and 3 months after competition. Ten controls were examined at baseline and after 3 months. All images were analyzed by two musculoskeletal radiologists identifying and grading cartilage, meniscal, ligamentous. and other knee abnormalities with WORMS scores. Meniscal segmentation was performed to generate T1rho and T2 maps in six compartments. RESULTS: No differences in morphological knee abnormalities were found before and after the marathon. However, all marathon runners showed a significant increase in T1rho and T2 values after competition in all meniscus compartments (p < 0.0001), which may indicate changes in the biochemical composition of meniscal tissue. While T2 values decreased after 3 months T1rho values remained at a high level, indicating persisting changes in the meniscal matrix composition after a marathon. CONCLUSION: T2 values in menisci have the potential to be used as biomarkers for identifying reversible meniscus matrix changes indicating potential tissue damage. T1rho values need further study, but may be a valuable marker for diagnosing early, degenerative changes in the menisci following exercise

Genome-Wide Association Study and Gene Expression Analysis Identifies CD84 as a Predictor of Response to Etanercept Therapy in Rheumatoid Arthritis

Anti-tumor necrosis factor alpha (anti-TNF) biologic therapy is a widely used treatment for rheumatoid arthritis (RA). It is unknown why some RA patients fail to respond adequately to anti-TNF therapy, which limits the development of clinical biomarkers to predict response or new drugs to target refractory cases. To understand the biological basis of response to anti-TNF therapy, we conducted a genome-wide association study (GWAS) meta-analysis of more than 2 million common variants in 2,706 RA patients from 13 different collections. Patients were treated with one of three anti-TNF medications: etanercept (n = 733), infliximab (n = 894), or adalimumab (n = 1,071). We identified a SNP (rs6427528) at the 1q23 locus that was associated with change in disease activity score (ΔDAS) in the etanercept subset of patients (P = 8×10-8), but not in the infliximab or adalimumab subsets (P>0.05). The SNP is predicted to disrupt transcription factor binding site motifs in the 3′ UTR of an immune-related gene, CD84, and the allele associated with better response to etanercept was associated with higher CD84 gene expression in peripheral blood mononuclear cells (P = 1×10-11 in 228 non-RA patients and P = 0.004 in 132 RA patients). Consistent with the genetic findings, higher CD84 gene expression correlated with lower cross-sectional DAS (P = 0.02, n = 210) and showed a non-significant trend for better ΔDAS in a subset of RA patients with gene expression data (n = 31, etanercept-treated). A small, multi-ethnic replication showed a non-significant trend towards an association among etanercept-treated RA patients of Portuguese ancestry (n = 139, P = 0.4), but no association among patients of Japanese ancestry (n = 151, P = 0.8). Our study demonstrates that an allele associated with response to etanercept therapy is also associated with CD84 gene expression, and further that CD84 expression correlates with disease activity. These findings support a model in which CD84 genotypes and/or expression may serve as a useful biomarker for response to etanercept treatment in RA patients of European ancestry. © 2013 Cui et al

Empowerment or Engagement? Digital Health Technologies for Mental Healthcare

We argue that while digital health technologies (e.g. artificial intelligence, smartphones, and virtual reality) present significant opportunities for improving the delivery of healthcare, key concepts that are used to evaluate and understand their impact can obscure significant ethical issues related to patient engagement and experience. Specifically, we focus on the concept of empowerment and ask whether it is adequate for addressing some significant ethical concerns that relate to digital health technologies for mental healthcare. We frame these concerns using five key ethical principles for AI ethics (i.e. autonomy, beneficence, non-maleficence, justice, and explicability), which have their roots in the bioethical literature, in order to critically evaluate the role that digital health technologies will have in the future of digital healthcare

Physical pretreatment of biogenic-rich trommel fines for fast pyrolysis

Energy from Waste (EfW) technologies such as fluidized bed fast pyrolysis, are beneficial for both energy generation and waste management. Such technologies, however face significant challenges due to the heterogeneous nature, particularly the high ash contents of some municipal solid waste types e.g. trommel fines. A study of the physical/mechanical and thermal characteristics of these complex wastes is important for two main reasons; (a) to inform the design and operation of pyrolysis systems to handle the characteristics of such waste; (b) to control/modify the characteristics of the waste to fit with existing EFW technologies via appropriate feedstock preparation methods. In this study, the preparation and detailed characterisation of a sample of biogenic-rich trommel fines has been carried out with a view to making the feedstock suitable for fast pyrolysis based on an existing fluidized bed reactor. Results indicate that control of feed particle size was very important to prevent problems of dust entrainment in the fluidizing gas as well as to prevent feeder hardware problems caused by large stones and aggregates. After physical separation and size reduction, nearly 70. wt% of the trommel fines was obtained within the size range suitable for energy recovery using the existing fast pyrolysis system. This pyrolyzable fraction could account for about 83% of the energy content of the 'as received' trommel fines sample. Therefore there was no significant differences in the thermochemical properties of the raw and pre-treated feedstocks, indicating that suitably prepared trommel fines samples can be used for energy recovery, with significant reduction in mass and volume of the original waste. Consequently, this can lead to more than 90% reduction in the present costs of disposal of trommel fines in landfills. In addition, the recovered plastics and textile materials could be used as refuse derived fuel