Academic medical centers: A framework for strategic repositioning

This study sought to understand the elements affecting the success or failure of strategic repositioning efforts by academic medical centers (AMC). The research question was: What specific elements in the process appear to be most important in determining the success or failure of an AMC.s strategic repositioning? Where success is based on the longterm sustainability of the new position.^ "An organization's strategic position is its perceptual location relative to others" (Gershon, 2003). Hence, strategic repositioning represents a shift from one strategic position within an environment to another (H. Mintzberg, 1987a). A deteriorating value proposition coupled with an unsustainable national health care financing system is forcing AMCs to change their strategic position. Where the value proposition is defined as the health outcome per dollar spent. ^ AMCs are of foundational importance to our health care system. They educate our new physicians, generate significant scientific breakthroughs, and care for our most difficult patients. Yet, their strategic, financial and business acumen leaves them particularly vulnerable in a changing environment. ^ After a literature review revealed limited writing on this subject, the research question was addressed using three separate but parallel exploratory case study inquiries of AMCs that recently underwent a strategic repositioning. Participating in the case studies were the Baylor College of Medicine, the University of Texas M. D. Anderson Cancer Center, and the University of Texas Medical Branch.^ Each case study consisted of two major research segments; a thorough documentation review followed by semi-structured interviews of selected members of their governance board, executive and faculty leadership teams. While each case study.s circumstances varied, their response to the research question, as extracted through thematic coding and analysis of the interviews, had a high degree of commonality.^ The results identified managing the strategic risk surrounding the repositioning and leadership accountability as the two foundational elements of success or failure. Metrics and communication were important process elements. They both play a major role in managing the strategic repositioning risk communication loop. Sustainability, the final element, was the outcome sought.^ Factors leading to strategic repositioning included both internal and external pressures and were primarily financial or mission based. Timing was an important consideration as was the selection of the strategic repositioning endpoint.^ In conclusion, a framework for the strategic repositioning of AMCs was offered that integrates the findings of this study; the elements of success, the factors leading to strategic repositioning, and the risk communication loop. ^

Cataract surgery in cancer patients and its impact on quality of life as measured by the National Eye Institute Visual Functioning Questionnaire - 25 (NEI-VFQ-25)

Purpose. The measurement of quality of life has become an important topic in healthcare and in the allocation of limited healthcare resources. Improving the quality of life (QOL) in cancer patients is paramount. Cataract removal and lens implantation appears to improve patient well-being of cancer patients, though a formal measurement has never been published in the US literature. In this current study, National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), a validated vision quality of life metric, was used to study the change in vision-related quality of life in cancer patients who underwent cataract extraction with intraocular lens implantation. ^ Methods. Under an IRB approved protocol, cancer patients who underwent cataract surgery with intraocular lens implantation (by a single surgeon) from December 2008 to March 2011, and who had completed a pre- and postoperative NEI-VFQ-25 were retrospectively reviewed. Post-operative data was collected at their routine 4-6 week post-op visit. Patients' demographics, cancer history, their pre and postoperative ocular examinations, visual acuities, and NEI-VFQ-25 with twelve components were included in the evaluation. The responses were evaluated using the Student t test, Spearman correlation and Wilcoxon signed rank test. ^ Results. 63 cases of cataract surgery (from 54 patients) from the MD Anderson Cancer Center were included in the study. Cancer patients had a significant improvement in the visual acuity (P<0.0001) postoperatively, along with a significant increase in vision-related quality of life (P<0.0001). Patients also had a statistically significant improvement in ten of the twelve subcategories which are addressed in the NEI-VFQ-25. ^ Conclusions. In our study, cataract extraction and intraocular implantation showed a significant impact on the vision-related quality of life in cancer patients. Although this study includes a small sample size, it serves as a positive pilot study to evaluate and quantify the impact of a surgical intervention on QOL in cancer patients and may help to design a larger study to measure vision related QOL per dollar spent for health care cost in cancer patients.^

Measuring value in cancer-related health care: A case study in head and neck cancer

In the current climate of escalating health care costs, defining value and accurately measuring it are two critical issues affecting not only the future of cancer care in particular but also the future of health care in general. Specifically, measuring and improving value in cancer-related health care are critical for continued advancements in research, management, and overall delivery of care. However, in oncology, most of this research has focused on value as it relates to insurance industry and payment reform, with little attention paid to value as the output of clinical interventions that encompass integrated clinical teams focusing on the entire cycle of care and measuring objective outcomes that are most relevant to patients. ^ In this study, patient-centered value was defined as health outcomes achieved per dollar spent, and calculated using objective functional outcomes and total care costs. The analytic sample comprised patients diagnosed with three common head and neck cancers—cancer of the larynx, oral cavity, and oropharynx—who were treated in an integrated tertiary care center over an approximately 10-year period. The results of this study provide initial empirical data that can be used to assess and ultimately to help improve the quality and value of head and neck cancer care, and more importantly they can be used by patients and clinicians to make better-informed decisions about care, particularly what therapeutic services and outcomes matter the most to patients.^

Evaluation of the Newly-developed, Least-cost Experimental Diet for Bluegill at Commercial Densities in Ponds

A substantial need exists to reduce costs and develop more nutritionally adequate diets for established as well as emerging aquaculture species in the North Central Region (NCR). The study evaluated a diet for juvenile northern bluegill (Lepomis macrochirus) that is significantly less costly than currently available diets for sunfish, while yielding a growth rate that is at least equal to an industry standard sunfish diet. Such a diet formulation is now available to the NCR as the result of a recently funded North Central Regional Aquaculture Center (NCRAC) project.

Web-based Biodiversity Citizen Science Database (assembled 2012)

The collective impact of humans on biodiversity rivals mass extinction events defining Earth's history, but does our large population also present opportunities to document and contend with this crisis? We provide the first quantitative review of biodiversity-related citizen science to determine whether data collected by these projects can be, and are currently being, effectively used in biodiversity research. We find strong evidence of the potential of citizen science: within projects we sampled (n = 388), ~1.3 million volunteers participate, contributing up to US Dollar 2.5 billion in-kind annually. These projects exceed most federally-funded studies in spatial and temporal extent, and collectively they sample a breadth of taxonomic diversity. However, only 12% of the 388 projects surveyed obviously provide data to peer-reviewed scientific articles, despite the fact that a third of these projects have verifiable, standardized data that are accessible online. Factors influencing publication included project spatial scale and longevity and having publically available data, as well as one measure of scientific rigor (taxonomic identification training). Because of the low rate at which citizen science data reach publication, the large and growing citizen science movement is likely only realizing a small portion of its potential impact on the scientific research community. Strengthening connections between professional and non-professional participants in the scientific process will enable this large data resource to be better harnessed to understand and address global change impacts on biodiversity.

Trade, Exchange Rates, and Macroeconomic Dynamics in East Asia: Why the Electronics Cycle Matters

Against the background of increasing regional trade and investment, there is growing interest in monetary and macroeconomic policy coordination in East Asia. Although there is a sizable literature on macroeconomic linkages among East Asian countries and the potential merit of policy coordination in the region, the existing studies tend to examine these issues exclusively in terms of macroeconomic variables and do not consider how these aggregate variables are influenced by one prominent feature of a number of East Asian economies: their heavy dependence on the electronics industry. Although active engagement in the global electronics industry has been a powerful growth engine for the Asian countries, it has also left their economies vulnerable to cyclical fluctuations in the world electronics market. As the cycle of the global electronics industry exerts profound impacts on the medium-term dynamics of the Asian economies, it is imperative to take an explicit account of its influence when studying the way in which the regional economies are linked to one another and how this relationship can be altered by a specific policy initiative. We illustrate the importance of this point by examining recent studies on: (1) trade competition between China andother Asian countries and the role of the Chinese renminbi therein; and (2) the effect offluctuations in the yen/dollar exchange rate on the regional economies.

Real exchange rate appreciation, resource boom, and policy reform in Myanmar

In the five-year period from 2006 to 2011, the real exchange rate of the Myanmar kyat appreciated 200 percent, signifying that the value of the US dollar in Myanmar diminished to one third of its previous level. While the resource boom is suspected as a source of the real exchange rate appreciation, its aggravation is related to administrative controls on foreign exchange and imports. First, foreign exchange controls prevented replacement of the negotiated transactions of foreign exchange with the bank intermediation. This hampered government interventions in the market. Second, import controls repressed imports, aggravating excess supply of foreign exchange. Relaxation of administrative controls is necessary for moderating currency appreciation.

An Evening with Dr. Venus Opal Reese, Motivational Speaker, Business Woman, and Author

This Droppin' Knowledge Lecture Series will challenge the audience to "defy the impossible". Dr. Venus Opal Reese will offer insight on how to achieve success on Thursday, September 17, at 6:30pm in Martin Luther King Hall-Thomas Pawley Theature, 812 E. Dunklin Street. Reese, an inspirational speaker, business mentor and marketing strategist, offers training to professionals, particularly entrepreneurs and executives, on how to "defy their impossible" to reach million-dollar success. Reese has consulted for O Magazines, and appeared on ABC and CBS News. For more information on Dr. Venus Opal Reese, please visit http://defyimpossible.com.

ANALISANDO A RELAÇÃO DOS VOLUMES DE EXPORTAÇÃO E DE IMPORTAÇÃO, PIB, TAXAS DE CÂMBIO E INFLAÇÃO NO PERÍODO DE 2004 A 2014.

Esta dissertação visa deslumbrar uma análise macroeconômica do Brasil, especialmente no que se refere à relação dos índices mensais dos volumes das exportações e das importações com os volumes mensais do PIB, da Taxa SELIC e as Taxas de Câmbio, conforme dados coletados no período de janeiro de 2004 a dezembro de 2014, através de pesquisa literária referente aos históricos sobre cada conceito envolvido no âmbito da macroeconomia das varáveis estudadas. Foi realizado um estudo de caso embasado em dados de sites governamentais, no período delimitado, empregando-se o método de regressão linear, com base na Teoria da correlação de Pearson, demonstrando os resultados obtidos no período do estudo para as varáveis estudadas. Desta maneira, conseguiu-se estudar e analisar como as variáveis dependentes (resposta): volume das exportações e volume das importações estão relacionadas com as varáveis independentes (explicativas): PIB, Taxa Selic e taxa de Câmbio. Os resultados apurados no presente estudo permitem identificar que existe correlação moderada e negativa, quando analisadas a Taxa Selic e a Taxa de Câmbio com os volumes das exportações e das importações, enquanto o PIB apresenta correlação forte e positiva na análise com os volumes das exportações e das importações

Genetic documentation of filial cannibalism in nature

Cannibalism is widespread in natural populations of fishes, where the stomachs of adults frequently contain conspecific juveniles. Furthermore, field observations suggest that guardian males routinely eat offspring from their own nests. However, recent genetic paternity analyses have shown that fish nests often contain embryos not sired by the nest-tending male (because of cuckoldry events, egg thievery, or nest piracy). Such findings, coupled with the fact that several fish species have known capabilities for distinguishing kin from nonkin, raise the possibility that cannibalism by guardian males is directed primarily or exclusively toward unrelated embryos in their nests. Here, we test this hypothesis by collecting freshly cannibalized embryos from the stomachs of several nest-tending darter and sunfish males in nature and determining their genetic parentage by using polymorphic microsatellite markers. Our molecular results clearly indicate that guardian males do indeed consume their own genetic offspring, even when unrelated (foster) embryos are present within the nest. These data provide genetic documentation of filial cannibalism in nature. Furthermore, they suggest that the phenomenon may result, at least in part, from an inability of guardians to differentiate between kin and nonkin within their own nests.

Sematech: Purpose and Performance

In previous research, we have found a steep learning curve in the production of semiconductors. We estimated that most production knowledge remains internal to the firm, but that a significant fraction “spills over” to other firms. The existence of such spillovers may justify government actions to stimulate research on semiconductor manufacturing technology. The fact that not all production knowledge spills over, meanwhile, creates opportunities for firms to form joint ventures and slide down their learning curves more efficiently. With these considerations in mind, in 1987 14 leading U.S. semiconductor producers, with the assistance of the U.S. government in the form of $100 million in annual subsidies, formed a research and development (R&D) consortium called Sematech. In previous research, we estimated that Sematech has induced its member firms to lower their R&D spending. This may reflect more sharing and less duplication of research, i.e., more research being done with each R&D dollar. If this is the case, then Sematech members may wish to replace any funding withdrawn by the U.S. government. This in turn would imply that the U.S. government’s contributions to Sematech do not induce more semiconductor research than would otherwise occur.

On the forecast accuracy and consistency of exchange rate expectations: The Spanish PwC Survey.

We examine the predictive ability and consistency properties of exchange rate expectations for the dollar/euro using a survey conducted in Spain by PwC among a panel of experts and entrepreneurs. Our results suggest that the PwC panel have some forecasting ability for time horizons from 3 to 9 months, although only for the 3-month ahead expectations we obtain marginal evidence of unbiasedness and efficiency in the forecasts. As for the consistency properties of the exchange rate expectations formation process, we find that survey participants form stabilising expectations in the short-run and destabilising expectations in the long- run and that the expectation formation process is closer to fundamentalists than chartists.

A Framework for Conceptualizing Psychologically Healthy Contemplative Practice.

In recent years contemplative practices such as Zen Buddhism and yoga have become increasingly utilized in the United States (Mann et al., 2001). The most visible contemplative practice in America today is the practice of yoga. According to a 2008 market study conducted by Yoga Journal, yoga was a 5.6 billion dollar industry in America in 2008. This market study also found that 15.8 million people, or 6.9% of American adults, practice yoga (Yoga Market Study, 2008). Zen Buddhism may be less visible than yoga in popular culture, yet its presence in the United States is substantial. While exact statistics are difficult to come by, Harvard University's Pluralism Project cites that the number of practicing Buddhists in America ranges from 2.4 to 4 million people, although it is unclear how many of these individuals practice Zen, or contemplative Buddhism (Pluralism Project Statistics, 2009). The popularity of Zen in America is further evidenced by the presence of Zen centers in most major cities. The sizeable and growing presence of Buddhism in America indicates a move towards the inclusion of contemplative practice in the cultural mainstream (Pluralism Project Statistics, 2009).

Aplicação e avaliação de desempenho de um sistema de otimização em tempo real em uma unidade de produção de propeno.

Com o objetivo de aumentar o lucro de plantas químicas, a Otimização em Tempo Real (RTO) é uma ferramenta que busca determinar as condições ótimas operacionais do processo em estado estacionário, respeitando as restrições operacionais estabelecidas. Neste trabalho foi realizada a implementação prática de um ciclo RTO em um processo de destilação por recompressão de vapor (VRD), propileno-propano, da Refinaria de Paulínia (Petrobras S.A.), a partir de dados históricos da planta. Foram consideradas as principais etapas de um ciclo clássico de RTO: identificação de estado estacionário, reconciliação de dados, estimação de parâmetros e otimização econômica. Essa unidade foi modelada, simulada e otimizada em EMSO (Environment for Modeling, Simulation and Optimization), um simulador de processos orientado a equações desenvolvido no Brasil. Foram analisados e comparados dois métodos de identificação de estado estacionário, um baseado no teste estatístico F e outro baseado em wavelets. Ambos os métodos tiveram resultados semelhantes e mostraram-se capazes de identificar os estados estacionários de forma satisfatória, embora seja necessário o ajuste de parâmetros na sua implementação. Foram identificados alguns pontos estacionários para serem submetidos ao ciclo RTO e foi possível verificar a importância de partir de um estado estacionário para a continuidade do ciclo, já que essa é uma premissa do método. A partir dos pontos analisados, os resultados deste estudo mostram que o RTO é capaz de aumentar o ganho econômico entre 2,5-24%, dependendo das condições iniciais consideradas, o que pode representar ganhos de até 18 milhões de dólares por ano. Além disso, para essa unidade, verificou-se que o compressor é um equipamento limitante no aumento de ganho econômico do processo.

[Note regarding College expenditures, 1794]

One leaf containing a handwritten note intended to justify the expenses of the College with financial figures about the salaries of past presidents and a list of the College's physical plant intended to indicate that "the annual charge for repairs & incidental expenses, it is hoped, will not appear immodest." The note is undated, but the "present arrears" of the College is listed as £198 indicating it was written before the use of the dollar sign. The note is accompanied by a brown paper packet marked "College Sundries" that originally housed the item.