The effects of CEO-board relations on hospital performance.

This article assesses the relationship between CEO-board relations and hospital financial performance. A study of 90 acute care California hospitals examined changes in the relations between the CEO and governing board over two time periods in 1985 and 1989. The results show that CEO-board participation is an effective governance mechanism that significantly enhances hospital performance.

Insiders and business directors on hospital boards and strategic change.

Many hospitals are eager to incorporate practices of boards in business organizations. Yet little evidence exists on the desirability of "corporate" board features in hospital settings. We examined the effects of two characteristics of corporate boards--the relative dominance of insiders and of directors with business-related occupations on strategic changes within hospitals. We studied 335 hospitals in California immediately following legislative reforms in 1982. We found that hospital boards with a higher proportion of insiders and business directors made more changes in their mix of services in response to legislative reform. In addition, this relationship held for nonproprietary hospitals but not for proprietary hospitals. Limitations and implications of the results are discussed.

Employer involvement in eldercare: an organizational adaptation perspective.

Social and demographic changes represent an important environmental challenge to organizations. Recent demographic changes in the United States have increased the potential importance of "eldercare" benefits in the workplace. In this research, I elaborate a number of important organizational and environmental determinants that influence the recognition and interpretation of eldercare issues and relate these considerations to the level of employer involvement in the care of elderly dependents, or eldercare.

Organizational performance and adaptation: effects of environment and performance on changes in board composition.

This study examined performance as a moderator of organizational adaptation to environmental change. Change in the composition of boards of directors was examined as a dependent variable reflecting organizational attempts to deal with changing external contingencies. We tested specific hypotheses in an analysis of 290 California hospitals over a seven-year period. Results indicate that hospitals change the composition of their boards to adapt to changing environmental contingencies but that the hospitals' performance moderates the rate of their response, with poorer performers being more willing to initiate changes in board composition than strong performers.

Turbulence at the top: a new perspective on governance structure changes and strategic change.

Organizational theorists have traditionally focused attention on the relationship between chief executive officer (CEO) succession and strategic change. This study extends that perspective and explores the effects of changes in an organization's management, ownership, and board of directors on the process of strategic change. The results of this research suggest that changes in ownership and board have significant independent and interactive effects on strategic change.

Theodore von karman and applied mathematics in america.

The emergence of applied mathematics as a discipline in the United States is traditionally associated with World War II. Hungarian-born Theodore von Kármán was among those who had waged a long and vigorous campaign well before the war to make applied mathematics respectable to engineers and mathematicians. While advocating the use of mathematics and physics to solve applied problems, he challenged the prevailing philosophy of engineering programs, locked horns with recalcitrant journal editors, and generally encountered the obstacles to building a discipline that cuts across conventional boundaries.

Preoperative chemotherapy followed by mastectomy for locally advanced breast cancer.

Six patients with advanced local-regional breast cancer were reviewed. Five out of the six patients previously had had radiation therapy as part of the initial therapy. All patients had preoperative cycles of combination chemotherapy, either CMF or CAF. The two stage III patients had greater than 75% reduction in measurable tumor mass, which allowed a conventional modified radical or radical mastectomy to be performed. Both of these patients are now disease free at 26 and 27 months. The four stage IV patients had lesser operations following the chemotherapy (two simple mastectomies, one simple mastectomy plus axillary resection, and one axillary debulking). Reconstruction utilized advancement flaps in three patients and split-thickness skin grafts in the other. None of the patients had postoperative wound problems, and none of the patients had further problems with local cancer control. All patients had combination chemotherapy starting two to six weeks following surgery. Preoperative chemotherapy followed by surgery plays an important role in management of locally advanced stage III and stage IV breast cancer.

Carcinoma of the larynx with mucosubstance production and neuroendocrine differentiation: an ultrastructural and immunohistochemical study.

Primary neuroendocrine tumors of the larynx appear to be extremely rare. We report a case of well-differentiated neuroendocrine carcinoma arising in the larynx of a 61-year-old white woman. This case was initially diagnosed as a lymph node metastasis in the neck from an unknown primary carcinoma. Extensive workup subsequently revealed that the larynx was the primary site of the tumor. An electron microscopic study of both the primary and metastatic tumors showed numerous neurosecretory-type granules. Immunohistochemical studies revealed positive immunoreactivity against calcitonin, somatostatin, and ACTH. However, the tumor also displayed focal exocrine differentiation and mucosubstance production. The patient underwent a supraglottic laryngectomy and radical neck dissection and was free of tumor 22 months postoperatively.

Nonpalpable breast lesions discovered by mammography.

Specimen mammography has been used at our medical center since January 1976, for the purpose of localizing and confirming the removal of mammographically identified, nonpalpable breast lesions. Forty patients were studied between Jan 1, 1976 and MFay 31, 1979, and 11 of these were found to have carcinoma. Nine of this group had surgical procedures that included axillary lymph node excision and there were no patients with positive axillary nodes. Frozen-section diagnosis was used in 22 patients and found to correlate well with permanent section diagnosis, providing the frozen section was obtained from the most suspicious area of the specimen. Needle localization was used in 15 patients and found to be of definite value in assuring excision of the mammographic abnormality. Three patients had a persistent mammographic lesion after the procedure was done and each of these was successfully managed by repeated biopsy using specimen roentgenography with needle localization.