Nike's tagline,"Just do it," is an inspirational call to action for the millions who wear the company's athletic gear. But in terms of corporate responsibility, Nike didn't always follow its own advice. In the 1990s, protesters railed against sweatshop conditions at some of its overseas suppliers and made Nike the global poster child for corporate ethical fecklessness. The intense pressure that activists exerted on the athletic apparel giant forced it to take a long, hard look at corporate responsibility--sooner than it might have otherwise. In this article, Simon Zadek, CEO of the UK-based institute AccountAbility, describes the bumpy route Nike has traveled to get to a better ethical place, one that cultivates and champions responsible business practices. Organizations learn in unique ways, Zadek contends, but they inevitably pass through five stages of corporate responsibility, from defensive ("It's not our fault") to compliance ("We'll do only what we have to") to managerial ("It's the business") to strategic ("It gives us a competitive edge") and, finally, to civil ("We need to make sure everybody does it"). He details Nike's arduous trek through these stages-from the company's initial defensive stance, when accusations about working conditions arose, all the way to its engagement today in the international debate about business's role in society and in public policy. As he outlines this evolution, Zadek offers valuable insights to executives grappling with the challenge of managing responsible business practices. Beyond just getting their own houses in order, the author argues, companies need to stay abreast of the public's evolving ideas about corporate roles and responsibilities. Organizations that do both will engage in what he calls"civil learning".

In the present study we analysed the perseverative behaviour of three apraxic patients (FG, CEO, and VCR) while they were pantomiming the use of common objects and during their real use. The three patients were found to perseverate from one trial to later ones aspects of a given action in the pantomiming and in real use tasks. In particular, our main result was a striking double dissociation between patients in perseverating hand and arm movements. Patients FG and CEO made more perseveration errors involving the hand than VCR did, whereas the perseverative errors made by VCR involving the arm were more numerous than those made by FG and CEO. The patients differed also in other aspects of the perseverations, e.g., their median lags. Results are used to exend previous theories developed in the linguistic domain to that of actions.

Growing interest in pay-for-performance and the level of chief executive officers' (CEOs') pay raises questions about the link between performance and compensation in the health sector. This study compares the compensation of nonprofit hospital CEOs in Ontario, Canada to the three longest reported and most used measures of hospital financial performance. Our sample consisted of 132 CEOs from 92 hospitals between 1999 and 2006. Unbalanced panel data were analyzed using fixed effects regression. Results suggest that CEO compensation was largely unrelated to hospital financial performance. Inflation-adjusted salaries appeared to increase over time independent of hospital performance, and hospital size was positively correlated with CEO compensation. The apparent upward trend in salary despite some declines in financial performance challenges the fundamental assumption underlying this article, that is, financial performance is likely linked to CEO compensation in Ontario. Further research is needed to understand long-term performance related to compensation incentives.

The concepts of health promotion, self-care and community participation emerged during the 1970s and, since then, their application has grown rapidly in the developed world, showing evidence of effectiveness. In spite of this, a major part of the population in the developing countries still has no access to specialized dental care such as endodontic treatment, dental care for patients with special needs, minor oral surgery, periodontal treatment and oral diagnosis. This review focuses on a program of the Brazilian Federal Government named CEOs (Dental Specialty Centers), which is an attempt to solve the dental care deficit of a population that is suffering from oral diseases and whose oral health care needs have not been addressed by the regular programs offered by the SUS (Unified National Health System). Literature published from 2000 to the present day, using electronic searches by Medline, Scielo, Google and hand-searching was considered. The descriptors used were Brazil, Oral health, Health policy, Health programs, and Dental Specialty Centers. There are currently 640 CEOs in Brazil, distributed in 545 municipal districts, carrying out dental procedures with major complexity. Based on this data, it was possible to conclude that public actions on oral health must involve both preventive and curative procedures aiming to minimize the oral health distortions still prevailing in developing countries like Brazil.

Rational nanostructure manipulation has been used to prepare nanocomposites in which multiwalled carbon nanotubes (MWCNTs) were embedded inside mesoporous layers of oxides (TiO(2), ZrO(2), or CeO(2)), which in turn contained dispersed metal nanoparticles (Pd or Pt). We show that the MWCNTs induce the crystallization of the oxide layer at room temperature and that the mesoporous oxide shell allows the particles to be accessible for catalytic reactions. In contrast to samples prepared in the absence of MWCNTs, both the activity and the stability of core-shell catalysts is largely enhanced, resulting in nanocomposites with remarkable performance for the water-gas-shift reaction, photocatalytic reforming of methanol, and Suzuki coupling. The modular approach shown here demonstrates that high-performance catalytic materials can be obtained through the precise organization of nanoscale building blocks.

BACKGROUND

Producing accessible, appropriate, and accountable medical care that improves the health of the populations served requires collaborative physician-organization relationships within which performance measurement across the continuum of care occurs. Governance and shared responsibility for performance improvement (PI) through organizational structure and process have proven to be particularly complex challenges.

UNASSIGNED

The Health Alliance of Central New York, based in Syracuse, New York, which consists in part of Crouse Hospital; ambulatory medical care sites and physicians; a physician organization, a physician-hospital organization, and an independent practice association; in February 1997 established a plan for a redesign of the PI system.

UNASSIGNED

In April 1998 the development of joint performance indicators, the Family of Measures, was undertaken. Recommendations for improvements necessary to correct process failures are referred to the medical staff executive committee and/or the appropriate coordinating committee, which then charges the appropriate service-line PI Council(s) with the responsibility for making those improvements.

CONCLUSIONS

Systemwide PI with collaborative decision making by process stakeholders has been a major cultural transition requiring a degree of organizational readiness. Support of the most senior levels of management is critical. Institutional silos do not support shared, participatory decision making and cannot be overcome without strong support from senior management and in many cases the direct support and involvement of the CEO. Integrating information systems represents a considerable challenge: to find hardware and software that will interface properly to produce desired results, to successfully interface computer support personnel into the PI process, and to ensure the commitment to the financial resources to meet the information system requirements. In addition, meaningful and material reengineering requires substantial physician input. Simply reducing length of stay or cost per case is not an outcome that is by and large a strong motivator for physicians. Projects must have meaning at the level of the individual physician to raise interest and create buy-in. Enduring success will be achieved only through achievement of material and salient improvements (for both physicians and the institution) in combination with careful alignment of physician and institutional incentives.

BACKGROUND

The objective of the study was to investigate the prevalence of glaucomatous damage in normotensive fellow eyes of patients with unilateral high-tension pseudoexfoliation (PX) glaucoma.

METHODS

Initial examination records of 111 patients with unilateral PX glaucoma with intraocular pressure (IOP)>> or = 22 mmHg in the hypertensive eye and IOP < or = 21 mmHg in the normotensive fellow eye without any prior antiglaucomatous treatment were retrospectively studied. Visual field and optic disc examination results were evaluated for glaucomatous damage in the normotensive eyes.

RESULTS

Glaucomatous changes were detected in 45 of the 111 fellow eyes (40%). The damage was mild in 25 eyes (22%), moderate in 18 eyes (16%), and severe in 2 (2%). The factors significantly associated with glaucomatous findings in the normotensive eyes were clinical detection of PX, higher age >> or =70 years), higher maximal IOP >> or =18 mmHg) and wider IOP fluctuation >> or =6 mmHg) in the univariate analyses. In the multivariate analysis, associated factors remained as higher maximal IOP (odds ratio = 7.92, confidence interval = 2.82-22.23, P < 0.001) and wider IOP fluctuation (odds ratio = 5.67, confidence interval = 2.05-15.74, P = 0.001).

CONCLUSIONS

Normotensive fellow eyes of patients with unilateral high-tension PX glaucoma are under significant risk of glaucomatous damage, related with the level and the fluctuation range of IOP.

Facial appearance has a well-documented effect on perceived leadership ability. Face judgments of leadership ability predict political election outcomes across the world, and similar judgments of business CEOs predict company profits. Body height is also associated with leadership ability, with taller people attaining positions of leadership more than their shorter counterparts in both politics and in the corporate world. Previous studies have found some face characteristics that are associated with leadership judgments, however there have been no studies with three-dimensional faces. We assessed which facial characteristics drive leadership judgments in three-dimensional faces. We found a perceptual relationship between height and leadership ability. We also found that facial maturity correlated with leadership judgments, and that faces of people with an unhealthily high body mass index received lower leadership ratings. We conclude that face attributes associated with body size and maturity alter leadership perception, and may influence real-world democratic leadership selection.

Several studies have indicated that glucocorticoids are involved in maturation of mammalian oocytes. Recently, maturation of porcine oocytes in culture was shown to be inhibited by glucocorticoids in a time- and dose-dependent manner. In addition, levels of cortisol available for biological action in fluid of preovulatory follicles are higher than that present in circulation. The present study evaluates the effect of cortisol and dexamethasone on mouse cumulus enclosed oocytes (CEO) undergoing spontaneous- and FSH-induced maturation during a 24h culture period using breakdown of the germinal vesicle (GVBD) as end-point. FSH-induced oocyte maturation was studied using media containing 4.5mM hypoxanthine to maintain levels of cAMP elevated, whereas spontaneous oocyte maturation was studied in a medium without hypoxanthine. In the presence of FSH (25 IU/l) the rate of GVBD was significantly elevated compared to the control. Dexamethasone (1-20 microg/ml) in combination with FSH resulted in a rate of GVBD similar to FSH alone. Cortisol (0.1-10 microg/ml) resulted in a significant higher rate of GVBD in combination with a physiological concentration of FSH (10 IU/l) as compared to the control but similar to that caused by FSH alone. Nearly all CEO that matured spontaneously resumed meiosis irrespective of whether or not cortisol was present. In conclusion, these results indicate that glucocorticoids have little or no influence on the regulation of oocyte maturation in the mouse. Species differences between mouse and pig oocytes may exist.

BACKGROUND

Evidence-based management assumes that available research evidence is consistent with the problems and decision-making conditions faced by those who will utilize this evidence in practice.

OBJECTIVE

This article attempts to identify how hospital leaders view key determinants of hospital quality and costs, as well as the fundamental ways these leaders "think" about solutions to quality and cost issues in their organizations. The objective of this analysis is to better inform the research agenda and approaches pursued by health services research so that this research reflects the "realities" of practice in hospitals.

METHODS

We conducted a series of semistructured interviews with a convenience sample of eight hospital and three health system leaders. Questions focused on current and future challenges facing hospitals as they relate to hospital quality, costs, and efficiency, and potential solutions to those challenges.

RESULTS

Nine major organizational and managerial factors emerged from the interviews, including staffing, evidence-based practice, information technology, data availability and benchmarking, and leadership. Hospital leaders tend to think about these factors systemically and consider process-related factors as the important drivers of cost and quality.

CONCLUSIONS

The results suggest a need to expand the methods utilized by health services researchers to make their research more relevant to health care managers. Expanding research methods to reflect the systemic way that managers view the challenges and solutions facing their organizations may enhance the application of research findings into management practice. Finally, better communication is needed between the research and practice communities. Researchers must learn to think more like managers if their research is to be relevant, and managers must learn to more effectively communicate their issues with the research community and frame their problems in researchable terms.

Ceria nanoparticles supported on aligned carbon nanotubes (CeO(2)/ACNTs), a novel adsorbent for Cr(VI) from drinking water, were prepared by chemical reaction of CeCl(3) with NaOH in aligned carbon nanotube solution and subsequent heat treatment. The best Cr(VI) adsorption effect of CeO(2)/ACNTs occurs at a pH range of 3.0-7.4. The largest adsorption capacity of CeO(2)/ACNTs reaches 30.2 mg g(-1) at an equilibrium Cr(VI) concentration of 35.3 mg l(-1) at pH 7.0. The experiment results suggest that CeO(2)/ACNTs have great potential applications in environmental protection.

We report on the preparation and characterization of CeO(2) nanofibers (CeO(2)-NFs) and nanocubes (CeO(2)-NCs), as well as Sm- and Gd-doped CeO(2) nanocubes (Sm-CeO(2)-NCs and Gd-CeO(2)-NCs), synthesized by a simple hydrothermal process for CO catalytic oxidation. The samples were characterized by X-ray diffraction (XRD), Brunauer-Emmett-Teller (BET), X-ray photoelectron spectroscopy (XPS), transmission electron microscopy (TEM), Raman spectroscopy, and photoluminescence spectroscopy. Their oxygen-storing capacity (OSC) was examined by means of hydrogen temperature-programmed reduction (H(2)-TPR) and oxygen pulse techniques. Their catalytic properties for CO catalytic oxidation were comparatively investigated. The results showed that the CeO(2)-NFs possessed a higher catalytic activity compared to the CeO(2)-NCs because of their smaller size and the greater number of oxygen vacancies. The activity of the Sm-CeO(2)-NCs was higher than that of the CeO(2)-NCs due to an increase in the number of oxygen vacancies, which results from the substitution of Ce(4+) species with Sm(3+) ions. In contrast, Gd doping had a negative effect on the CO catalytic oxidation due to the special electron configuration of Gd(3+) (4f(7)). Our work demonstrates that the oxygen vacancies in pure CeO(2) and the electron configuration of the dopants in doped CeO(2) play an important role in CO oxidation.

The vast majority of hospitals in the United States today are led by nonphysicians. This is in sharp contrast to the turn of the 20th century, when over a third of the hospitals in the United States were physician led. As the pendulum swings back from lay leader to clinician leader, there is a strong and appropriate opportunity for physicians to reinsert themselves into a leadership role. In fact, the time has perhaps never been more appropriate than today. In a health care system that is complex, troubled, and challenging, the physician CEO brings a unique set of skills to the business of medicine. The successful physician leader, however, must understand the business of medicine as well as or better than he or she understands the practice of medicine. Training, developing, and equipping our future physician leaders with the necessary skill sets will be one of medicines' many challenges as it expands into the 21st century.

Nowadays, a wide variety of nanoparticles (NPs) are applied in different fields such as medical science and industry. Due to their large commercial volume, the OECD Working Party on Manufactured Nanomaterials (NMs) has proposed to study a set of 14 nanomaterials, one of which being cerium oxide (CeO(2)). In particular, CeO(2) based NPs are widely used in automotive industry, healthcare, and cosmetics. In this paper, we propose a method for the production of radioactive CeO(2) NPs.We demonstrate that they maintain the same physicochemical characteristics as the “cold” ones in terms of size distribution and Zeta potential; we develop a new protocol to assess their cellular interaction in immortalized mouse fibroblast cell line Balb/3T3, a model for the study of basal cytotoxicity and carcinogenic potential induced by chemicals and in the present case by NPs. Experimental result of this work, which shows a quasi-linear concentration-uptake response of cells, can be useful as a reference dose-uptake curve for explaining effects following biological uptake after exposure to CeO(2) NPs.

A series of novel metal-oxide-supported CeO(2) catalysts were prepared via the wet impregnation method, and their NH(3)-SCR activities were investigated. The Ce/TiO(2)-SiO(2) catalyst with a Ti/Si mass ratio of 3/1 exhibited superior NH(3)-SCR activity and high N(2) selectivity in the temperature range of 250-450 °C. The characterization results revealed that the activity enhancement was correlated with the properties of the support material. Cerium was highly dispersed on the TiO(2)-SiO(2) binary metal oxide support, and the interaction of Ti and Si resulted in greater conversion of Ce(4+) to Ce(3+) on the surface of the catalyst compared to that on the single metal oxide supports. As a result of in the increased number of acid sites on Ce/TiO(2)-SiO(2) that resulted from the addition of SiO(2), the NH(3) adsorption capacity was significantly improved. All of these factors played significant roles in the high SCR activity. More importantly, Ce/TiO(2)-SiO(2) exhibited strong resistance to SO(2) and H(2)O poisoning. After the addition of SiO(2), the number of Lewis-acid sites was not decreased, but the number of Brønsted-acid sites on the TiO(2)-SiO(2) carrier was increased. The introduction of SiO(2) further weakened the alkalinity over the surface of the Ce/TiO(2)-SiO(2) catalyst, which resulted in sulfate not easily accumulating on the surface of the Ce/TiO(2)-SiO(2) catalyst in comparison with Ce/TiO(2).

Grain boundaries and interfaces of crystals have peculiar electronic structures, caused by the disorder in periodicity, providing the functional properties, which cannot be observed in a perfect crystal. In the vicinity of the grain boundaries and interfaces, dopants or impurities are often segregated, and they play a crucial role in deciding the properties of a material. Spherical aberration (Cs)-corrected scanning transmission electron microscopy (STEM), allowing the formation of sub-angstrom-sized electron probes, can directly observe grain boundary-segregated dopants. On the other hand, ceramic materials are composed of light elements, and these light elements also play an important role in the properties of ceramic materials. Recently, annular bright-field (ABF)-STEM imaging has been proposed, which is now known to be a very powerful technique in producing images showing both light- and heavy-element columns simultaneously. In this review, the atomic structure determination of ceramic grain boundaries and direct observation of grain boundary-segregated dopants and light elements in ceramics were shown to combine with the theoretical calculations. Examples are demonstrated for well-defined grain boundaries in rare earth-doped Al(2)O(3) and ZnO ceramics, CeO(2) and SrTiO(3) grain boundary, lithium battery materials and metal hydride, which were characterized by Cs-corrected high-angle annular dark-field and ABF-STEM. It is concluded that the combination of STEM characterization and first-principles calculation is very useful in interpreting the structural information and in understanding the origin of the properties in various ceramics.

OBJECTIVE

Complete esophageal obstruction (CEO) is a rare occurrence characterized by progressive esophageal stricture, which eventually causes lumen obliteration. With recent advances in flexible endoscopy, various innovative techniques exist for restoring luminal continuity. The primary aim of this study was to assess the efficacy and safety of patients undergoing combined antegrade-retrograde endoscopic dilation for CEO at our institution. The secondary aim was to review and highlight emerging techniques, outcomes, and adverse events after endoscopic treatment of CEO.

METHODS

Our electronic endoscopy database was retrospectively reviewed to identify patients who underwent combined antegrade and retrograde endoscopy for CEO. Patient and procedural data collected included gender, age, technical success, pre- and post-dysphagia scores, and adverse events.

RESULTS

Six patients (67 % male, mean age 71.6 years [range 63 - 80]) underwent technically successful esophageal reconstruction with combined antegrade-retrograde endoscopy. All patients noted improvement in dysphagia with mean pre-procedure dysphagia score of 4 reduced to 1.33 (range 0 - 3) post-procedure. There were no adverse events and mean follow-up time was 17.3 months (range 3 - 48).

CONCLUSIONS

Combined antegrade and retrograde endoscopic therapy for CEO is feasible and safe. We present our experience with endoscopic management of complete esophageal obstruction, and highlight emerging techniques, outcomes and adverse events related to this minimally invasive modality.

The Au(25)(SR)(18)/CeO(2) nanocluster catalyst showed high activity in the homocoupling of aryl iodides (e.g. up to 99.8% yield with iodobenzene) and excellent recyclability.

Semiconducting-ionic conductors have been recently described as excellent electrolyte membranes for low-temperature operation solid oxide fuel cells (LT-SOFCs). In the present work, two new functional materials based on zinc oxide (ZnO)-a legacy material in semiconductors but exceptionally novel to solid state ionics-are developed as membranes in SOFCs for the first time. The proposed ZnO and ZnO-LCP (La/Pr doped CeO₂) electrolytes are respectively sandwiched between two Ni0.8Co0.15Al0.05Li-oxide (NCAL) electrodes to construct fuel cell devices. The assembled ZnO fuel cell demonstrates encouraging power outputs of 158-482 mW cm-2 and high open circuit voltages (OCVs) of 1-1.06 V at 450-550 °C, while the ZnO-LCP cell delivers significantly enhanced performance with maximum power density of 864 mW cm-2 and OCV of 1.07 V at 550 °C. The conductive properties of the materials are investigated. As a consequence, the ZnO electrolyte and ZnO-LCP composite exhibit extraordinary ionic conductivities of 0.09 and 0.156 S cm-1 at 550 °C, respectively, and the proton conductive behavior of ZnO is verified. Furthermore, performance enhancement of the ZnO-LCP cell is studied by electrochemical impedance spectroscopy (EIS), which is found to be as a result of the significantly reduced grain boundary and electrode polarization resistances. These findings indicate that ZnO is a highly promising alternative semiconducting-ionic membrane to replace the electrolyte materials for advanced LT-SOFCs, which in turn provides a new strategic pathway for the future development of electrolytes.

Nuclear waste repositories are being installed in deep excavated rock formations in some places in Europe to isolate and store radioactive waste. In France, the Callovo-Oxfordian formation (COx) is a possible candidate for nuclear waste storage. This work investigates the applicability of CeO(2)-based oxides (CeO(2), Ce(0.8)Sm(0.2)O(2) and Ce(0.8)Zr(0.2)O(2)) for monitoring the pH of the COx pore water (T=25°C). The study is limited to the pH range between 5.5 and 13.2, which includes the pH values that have been encountered or are anticipated in the COx formation during its evolution as radioactive waste repository due mainly to alkalinisation, an increase in salinity, and a decrease in redox potential. Screen-printing was done to assemble electrodes and rapidly generate data sets. The electrochemical behavior of CeO(2)-based screen-printed electrodes (CeO(2)-based SPEs) was determined by cyclic voltammetry and electrochemical impedance spectroscopy. The use of the electrodes for pH sensing was then evaluated by potentiometric measurements. The feasibility of measuring pH with CeO(2)-based SPEs was first tested in NH(4)Cl/NH(3) buffer solutions, leading to electrode calibration over the widest range of pH, from around neutral to basic pH. Experiments were then conducted in NaHCO(3)/Na(2)CO(3) buffer samples similar to conditions prevailing in the COx formation. Ce(0.8)Zr(0.2)O(2) SPEs exhibit a near-Nernstian behavior (sensitivity -(51±2)mV/pH) in the pH range of 5.5-13.2 at 25°C. Electrode response was slightly affected by the direction of the pH change. Electrode reliability was clearly demonstrated for pH monitoring. Probes based on the same components, but more durably designed, could be considered for pH measurements in radioactive waste repositories.

Suprachoroidal haemorrhage occurs most commonly as an intraoperative or a postoperative complication of ocular surgery. Spontaneous suprachoroidal haemorrhage is rare. Herein a case is described of spontaneous suprachoroidal haemorrhage in a patient who received recombinant tissue plasminogen activator for the treatment of a myocardial infarction. Systemic thrombolysis may induce spontaneous suprachoroidal haemorrhage. Prompt diagnosis and treatment can improve the likelihood of a favourable visual outcome. To the authors' knowledge, there have been only three previous reports in the literature of spontaneous suprachoroidal haemorrhage secondary to thrombolysis.

Estimating the environmental exposure to manufactured nanomaterials is part of risk assessment. Because nanoparticles aggregate with each other (homoaggregation) and with other particles (heteroaggregation), the main route of the removal of most nanoparticles from water is aggregation, followed by sedimentation. The authors used water samples from two rivers in Europe, the Rhine and the Meuse. To distinguish between small (mainly natural organic matter [NOM]) particles and the remainder of the natural colloids present, both filtered and unfiltered river water was used to prepare the particle suspensions. The results show that the removal of nanoparticles from natural river water follows first-order kinetics toward a residual concentration. This was measured in river water with less than 1 mg L(-1) CeO(2) nanoparticles. The authors inferred that the heteroaggregation with or deposition onto the solid fraction of natural colloids was the main mechanism causing sedimentation in relation to homoaggregation. In contrast, the NOM fraction in filtered river water stabilized the residual nanoparticles against further sedimentation for up to 12 d. In 10 mg L(-1) and 100 mg L(-1) CeO(2) nanoparticle suspensions, homoaggregation is likely the main mechanism leading to sedimentation. The proposed model could form the basis for improved exposure assessment for nanomaterials.

This study utilizes data from a national survey of 159 multihospital systems in order to describe the types of governance structures currently being utilized, and to compare the policy making process for various types of decisions in systems with different approaches to governance. Survey results indicate that multihospital systems most often use one of three governance models. Forty-one percent of the systems (including 33% of system hospitals) use a parent holding company model in which there is a system-wide corporate governing board and separate governing boards for each member hospital. Twenty-two percent of systems in the sample (but 47% of all system hospitals) utilize what we have termed a modified parent holding company model in which there is one system-wide governing board, but advisory boards are substituted for governing boards at the local hospital level. Twenty-three percent of the sampled systems (including 11% of system hospitals) use a corporate model in which there is one system-wide governing board but no other governing or advisory boards at either the divisional, regional or local hospital levels. A comparison of systems using these three governance approaches found significant variation in terms of system size, ownership and the geographic proximity of member hospitals. In order to examine the relationship between alternative approaches to governance and patterns of decision-making, the three model types were compared with respect to the percentages of systems reporting that local boards, corporate management and/or system-wide corporate boards have responsibility for decision-making in a number of specific issue areas. Study results indicate that, regardless of model type, corporate boards are most likely to have responsibility for decisions regarding the transfer, pledging and sale of assets; the formation of new companies; purchase of assets greater than $100,000; changes in hospital bylaws; and the appointment of local board members. In contrast corporate management is relatively uninvolved in these issues, again regardless of governance model type. There is substantial variation in the locus of decision-making responsibility by governance model type for a variety of other issues, however, including: hospital-level service additions and deletions; operating and capital budgets; medical staff privileges, hospital-level long-range planning; hospital CEO performance evaluation and the appointment of hospital CEOs.(ABSTRACT TRUNCATED AT 400 WORDS)