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BACKGROUND Survivors of childhood cancer are prone to an increased risk of chronic issues such as cardiovascular disease, fatigue, weight-related problems, and emotional disturbances. OBJECTIVE This study utilized the biopsychosocial model to examine the hypothesis that greater depression and lower mobility would be significantly associated with greater fatigue and higher body mass index in survivors of childhood cancer. METHODS Data were analyzed for 144 children treated and followed up for an oncology condition at a southeastern academic medical center. Voluntarily, children completed the Patient-Reported Outcomes Measurement Information System 1.0, and parents completed the Family Symptom Inventory as part of a brief annual psychosocial screening battery. Height and weight were collected by a clinic nurse prior to questionnaire completion. RESULTS Hierarchical linear regression showed that shorter time since diagnosis (β = -.154, P < .05), greater child-reported depression (β = .396, P < .01), and lower mobility (β = .427, P < .01) significantly predicted greater fatigue (adjusted R = 0.54). Older age (β = .262, P < .01) and not receiving chemotherapy (β = -.209, P < .05) significantly predicted higher body mass index (adjusted R = 0.051). CONCLUSIONS Findings showed that fatigue tends to improve over time after treatment but may be predicted by greater depression symptoms and lower mobility in recent survivors of childhood cancer. IMPLICATIONS FOR PRACTICE For survivors of childhood cancer with higher levels of fatigue, treating symptoms of depression and maximizing physical and mobility may be of clinical value. With the impact of psychological and social factors not yet understood in pediatric cancer survivors, weight status in recent survivors of childhood cancer is likely a complex interaction between biological and treatment factors.

OBJECTIVE Late-onset sepsis (LOS) in neonates contributes significantly to both morbidity and mortality. To determine the incidence of LOS, risk factors for disease and the impact on subsequent hospital course, we evaluated a cohort of 6340 neonates admitted to the neonatal intensive care unit and of neonates (3-28 days) admitted from the community between January 2005 and January 2016. METHODS This was a retrospective case review of all neonates admitted with suspected LOS who had positive blood culture and/or cerebrospinal fluid cultures, for an organism determined to be a pathogen. RESULTS Of 6340 neonates who survived beyond 3 days, 2271 (35.8%) had 1 or more blood cultures collected for suspected LOS. Of these, 146 (6.4%) positive blood cultures were thought to represent true bacteremia. The vast majority of infections (73%) were caused by Gram-positive organisms, with coagulase-negative staphylococci accounting for 39.8% of infections. Late-onset neonatal sepsis occurred predominantly in the 24-28-week age group (75.9%) and in neonates who weighed less than 1000 g (73.6%). The incubation time for positive blood cultures for Gram-negative sepsis was less (13 hours) when compared with Gram-positive sepsis (20 hours). Thrombocytopenia, elevated C-reactive protein and chorioamnionitis were consistently associated with late-onset Gram-negative sepsis (P < 0.05). Eight neonates (6%) died secondary to LOS. CONCLUSIONS LOS contributes significantly to mortality and morbidity in neonates and remains a challenge to clinicians. Necessary steps to reduce late-onset neonatal sepsis should be undertaken.

Hirschsprung disease (HD) is a congenital bowel innervation disorder characterized by the absence of ganglion cells in the neural plexus of the colorectal wall. Variant HD describes a heterogeneous group of intestinal innervation disorders in which clinical presentation resembles HD despite the presence of ganglion cells seen in rectal biopsies. We present the first reported case of a rare variant HD, hypoganglionosis isolated in the anorectal canal, diagnosed in an adult who presented with a long history of constipation and treated with proctosigmoidectomy with coloanal anastomosis. Histopathology showed rare ganglion cells isolated in the anorectal canal.

Many small- and medium-sized physician practices have developed specific programs and models toward becoming a successful patient-centered medical home. This article reports on a case-control quality improvement study of a multilingual population health management program for chronic disease management at International Community Health Services. In its first 2.5 years of operation, the International Community Health Services Population Health Management program for patients with hypertension and diabetes is associated with significant improvements in key health outcome measures for blood pressure and hemoglobin A1c control. This has significant implications for similar practices.

Dr. Verna Gibbs describes the "NoThing Left Behind" Program designed to eliminate retained devices from surgical procedures. She explains the genesis of the program along with adjuncts to counting including computer-assisted sponge count, radiofrequency detection system, radiofrequency identification system, and the Sponge ACCOUNTing system. She provides comments on the use of these adjuncts with responses on their effectiveness on improving safety.

Kent Bottles, MD, President of the Institute for Clinical Systems Improvement (ICSI). Dr. Bottles is a board-certified pathologist who specialized in surgical and cyto-pathology. He earned a medical degree from Case Western Reserve University in Ohio. He has extensive experience in integrated healthcare delivery systems, research, academia, commercial laboratories, genomics, proteomics, and management of biotech start-up companies. Dr. Bottles was vice president and chief medical officer of the Iowa Health System. Before that, he served as president and CEO of Grand Rapids Medical Education and Research Center for Health Professions, a multi-institutional consortium of healthcare organizations, and as president of Genomics Repository and chief knowledge officer, Genomics Collaborative Inc. Dr. Bottles has extensive academic experience, serving as Professor and Acting Head, Department of Pathology and Laboratory Medicine at the University of Iowa. He was also the founding medical director of managed care plans for University of Iowa employees. Dr. Bottles has addressed topics ranging from quality and patient safety and disruptive technology to patient-physician relationships and the future of medicine. He has received numerous honors, including the Rodney T. West Literary Achievement Award for the most important article on medical management presented by the American College of Physician Executives. He has broad clinical experience with the University of Iowa and the San Francisco General Hospital, and has been a national leader in changing the practice of pathology and laboratory medicine to meet the challenges of managed care.

E. Scott Geller, PhD, is a senior partner of Safety Performance Solutions, Inc., Blacksburg, VA, which specializes in behavior-based safety training and consulting. Geller addresses the human dynamics of occupational safety. He is an alumni distinguished professor at Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA, and director of the Center for Applied Behavior Systems in the department of psychology. He is past editor of Journal of Applied Behavior Analysis (1989–1992), associate editor (since 1983) of Environment and Behavior, and consulting editor for Journal of Safety Research, Behavior and Social Issues, Behavior Analyst Digest, and Journal of Organizational Behavior Management. In the department of psychology at Virginia Tech, he was the principal investigator on 80 research grants, and he has authored more than 350 research articles and more than 75 books or chapters addressing the development and evaluation of behavior-change interventions to improve the quality of life. Geller publishes the regular column “Psychology of Safety'' in Industrial Safety and Hygiene News. His recent books in occupational health and safety include The Psychology of Safety; Working Safe; Understanding Behavior-Based Safety; Building Successful Safety Teams; Beyond Safety Accountability: How to Increase Personal Responsibility; The Psychology of Safety Handbook; Keys to Behavior-Based Safety from Safety Performance Solutions; The Participation Factor; and People-Based Safety: The Source. His most recent book is The Anatomy of Medical Error: Preventing Harm with People-Based Patient Safety. In 2001, Virginia Tech awarded him the University Alumni Award for Excellence in Research and in 2002 honored him with the Alumni Outreach Award for his exemplary real-world applications of behavioral science. In 2005, he was awarded the statewide Virginia Outstanding Faculty Award by the State Council of Higher Education.

Tania Daniels, MBA PT, is the vice president for patient safety at the Minnesota Hospital Association (MHA), St. Paul, MN. She has worked in the healthcare industry for more than 15 years. She received her bachelor of science degree in physical therapy in 1993 and practiced physical therapy at the University of Minnesota-Fairview for 7 years. She received a master of business administration degree with a concentration in healthcare from the University of St. Thomas, St. Paul, MN, in 2000. Daniels provides patient safety expertise for MHA and convenes patient safety stakeholders throughout Minnesota to build consensus on key safety topics. She serves as lead staff member for the Minnesota Alliance for Patient Safety (MAPS), a voluntary coalition of more than 50 healthcare stakeholders. MAPS was established in 2000 as a partnership between the MHA, the Minnesota Medical Association, and the Minnesota Department of Health; its membership includes more than 50 public and private healthcare organizations. MAPS was the recipient of the John M. Eisenberg Patient Safety and Quality Award for innovation at a regional level. She is a member of the planning committee for the Minnesota Executive Session on Patient Safety.

William L. Roper, MD MPH, is dean of the School of Medicine, vice chancellor for medical affairs, and CEO of the University of North Carolina (UNC) Health Care System at UNC-Chapel Hill. He is also professor of health policy and administration in the School of Public Health (where he was dean from 1997 to March 2004) and professor of pediatrics in the School of Medicine at UNC. He had previously served as senior vice president of Prudential HealthCare. Before going to Prudential, he was director of the Centers for Disease Control and Prevention (CDC) and served on the senior White House staff as administrator of the Health Care Financing Administration, which is responsible for Medicare and Medicaid. He was also a White House Fellow. Roper received his MD from the University of Alabama School of Medicine and his master's in public health from the School of Public Health at the University of Alabama-Birmingham. He completed his residency in pediatrics at the University of Colorado Medical Center. He is a member of the Institute of Medicine (IOM) of the National Academy of Sciences, the board of trustees of the Robert Wood Johnson Foundation, the board of directors of DaVita, Inc., and the Delhaize Group, and the President's Commission on White House Fellowships. He also chairs the board of directors of the National Quality Forum.

Objectives: Biliary atresia (BA), a congenital idiopathic obliterative cholangiopathy, rapidly leads to liver cirrhosis and liver failure if untreated. A timely Kasai portoenterostomy (KP) variably alters this natural history. We evaluated liver fibrogenesis by the intensity of alpha-smooth-muscle actin (SMA) expression, which is a marker for hepatic stellate cell activation. We hypothesized that liver fibrogenesis as determined by intensity of alpha-SMA is already progressing at the time of KP, is related to age and degree of fibrosis at KP, and predicts outcome after KP.Methods: BA patients at KP (n = 22, age 22-84 days, median 59) had wedge liver biopsies assessed by quantitative morphometry of immunohistochemistry for alpha-SMA expression. Fibrosis was scored by blinded pathologists. Outcome, reflected by conjugated bilirubin concentration 3 months after KP (CBili3m), survival of the native liver, need for liver transplant, or death, were assessed for 2 to 10 years after KP.Results: At KP, age, fibrosis score, and alpha-SMA expression were significantly correlated. Moderate-severe fibrosis and intense alpha-SMA expression was observed in 15 of 22 (68%) patients. Severe fibrosis and high alpha-SMA expression were significantly associated with CBili3m greater than 2 g/dL and unfavorable liver survival (>90% of these ultimately underwent liver transplantation or died). Conversely, those with mild fibrosis and low alpha-SMA expression had normal CBili3m and favorable liver survival.Conclusion: Intense liver fibrogenesis is already established in many cases of BA at the time of KP. Fibrosis scores and intensity of alpha-SMA expression may be predictors of outcome after KP and may indicate those patients who might benefit from trials of potential antifibrotic agents early in the course of BA.

Objective Patient safety practices have primarily focused on providers, such as hospitals and ambulatory or long-term care. Based on the premise that most medical errors and patient safety problems arise from system issues, and that managed care constitutes the largest, most integrated system in health care, the authors examine the role of managed care in making patient care safer. Study design Review of the literature and analysis of the role of managed care in patient safety. Results Authors find that although much has been written regarding managed care and quality, there is little research on managed care's relationship to patient safety. Research shows that managed care is not significantly different from indemnity insurance in terms of quality of care. However, managed care contracting, reimbursement, and management practices result in health care utilization changes that could pose potential risks for patient safety. Although managed care may pose possible risks to patient safety, practices can be monitored and adjusted to maintain quality and safety. At the same time, managed care provides opportunities for promoting patient safety at an integrated system level. Managed care organizations are in a unique position to influence patient safety by using safety strategies in selective contracting, financial incentives for performance, quality improvement programs, consumer education, and management and integration of care delivery. Our literature review reveals that health plans are starting to implement some of these strategies, but the practice is not widespread. Conclusions Authors conclude with a framework and recommendations for patient safety.

David Brailer, MD PhD, was appointed the first National Health Information Technology Coordinator by the U.S. Department of Health and Human Services Secretary Tommy Thompson on May 6, 2004. As National Coordinator he is to execute President Bush's Executive Order of April 27, 2004, calling for widespread deployment of health information technology (HIT) within 10 years. Dr. Brailer is an authority on clinical data sharing, local health information exchanges, and the use of peer-to-peer technologies in healthcare. He is a leader in the strategy and financing of quality and efficiency in healthcare, with a particular emphasis on HIT and health systems management. Previously, Dr. Brailer was a Senior Fellow at the Health Technology Center in San Francisco, advising a variety of regional and national data-sharing projects and several major corporations about the role of IT in improving the quality of healthcare. Dr. Brailer recently completed 10 years as Chairman and CEO of CareScience, Inc., a provider of care management services and Internet-based solutions that help reduce medical errors and improve physician and hospital-based performance. Dr. Brailer holds doctoral degrees in both medicine and economics. While in medical school, he was a Charles A. Dana Scholar at the University of Pennsylvania School of Medicine and the first recipient of the National Library of Medicine Martin Epstein Award for his work in expert systems. Dr. Brailer was among the first medical students to serve on the Board of Trustees of the American Medical Association.

Suzanne F. Delbanco, PhD MPH, is the first executive director of The Leapfrog Group, founded by the Business Roundtable. The Leapfrog Group's goal is to mobilize employer purchasing power to initiate breakthrough improvements in the safety, quality, and overall value of healthcare for American consumers. The group's growing consortium of more than 155 Fortune 500 companies and other large private and public healthcare purchasers provides health benefits to more than 34 million Americans; these companies spend more than 62 billion dollars on healthcare annually. Dr. Delbanco is a member of the National Committee for Quality Assurance Purchaser Advisory Council and a board member of Bridges to Excellence. Before joining The Leapfrog Group, she was a senior manager at the Pacific Business Group on Health (PBGH), where she worked on the quality team. Prior to joining PBGH, she worked on reproductive health policy and the changing healthcare marketplace initiative at the Henry J. Kaiser Family Foundation. She has also consulted on health insurance coverage in the temporary employment industry and on the first statewide survey in California of MediCal beneficiaries, and worked as a community Liaison for Kaiser Permanente during the establishment of one of California's first County Organized Health Systems. She holds a PhD in public policy from the Goldman School of Public PoLicy and a MPH from the School of Public Health at the University of California, Berkeley.

Carolyn M. Clancy, MD, serves as Director of the Agency for Healthcare Research and Quality (AHRQ) in the U.S. Department of Health and Human Services (DHHS). Prior to her appointment as director on February 5, 2003, Dr. Clancy served as AHRQ's acting director (since March 2002) and before that as director of AHRQ's Center for Outcomes and Effectiveness Research (COER). Dr. Clancy is a general internist and health services researcher and a graduate of Boston College and the University of Massachusetts Medical Schools. Following clinical training in internal medicine, Dr. Clancy was a Henry Kaiser Family Foundation Fellow at the University of Pennsylvania. She was also an assistant professor in the Department of Internal Medicine at the Medical College of Virginia in Richmond prior to joining AHRQ in 1990. Her major research interests include women's health, primary care, access to care, and the effect of financial incentives on physicians' decisions. She holds an academic appointment at The George Washington University School of Medicine (Clinical Associate Professor, Department of Medicine) and serves as Senior Associate Editor, Health Services Research. Dr. Clancy is a member of the editorial boards of several journals (American Journal of Public Health; Journal of Evaluation in Clinical Practice; Annals of Family Medicine, and Medical Care Research and Review), has published widely in peer-reviewed journals, and has edited or contributed to seven books.

Penny Hollander Feldman, PhD, is Vice President for Research and Evaluation at the Visiting Nurse Service of New York (VNSNY) and Director of the Center for Home Care Policy and Research. Prior to joining VNSNY, Dr. Feldman served on the faculties of the Kennedy School of Government and the Department of Health Policy and Management at the Harvard School of Public Health. At the Center for Home Care Policy and Research, she directs projects focused on improving the quality, outcomes, and cost-effectiveness of home-based care, supporting informed policymaking by long-term care decision makers, and helping communities promote the health, well-being and independence of people with chronic illness or disability. The translation and implementation of research in both service and policy settings has been an issue of ongoing focus for Dr. Feldman. She also served as a member of the Institute of Medicine Committee on Improving the Quality of Long-Term Care, which issued its report in 2001.

BACKGROUND: Placental site trophoblastic tumor is a rare form of gestational trophoblastic disease that commonly presents with vaginal bleeding and amenorrhea after pregnancy. CASE: A women with a normal gestation at 37 weeks presented with a pneumothorax. The patient underwent placement of a chest tube and a subsequent thorascopic pulmonary bullous resection for persistence of the pneumothorax. Histological examination of the specimen revealed a metastatic placental site trophoblastic tumor. CONCLUSION: Gestational trophoblastic disease must be considered in the differential diagnosis of pneumothorax during pregnancy.

Lucian L. Leape, MD, is a health policy analyst whose research has focused on error prevention and appropriateness of care. He is currently adjunct professor of health policy at the Harvard School of Public Health. Prior to joining the faculty at Harvard, he was professor of surgery at Tufts University School of Medicine and chief of pediatric surgery at the New England Medical Center. He has been a leading advocate of the nonpunitive systems approach to the prevention of medical error and has led several studies of adverse drug events and their underlying systems failures. In addition, he has directed research into overuse and underuse of cardiovascular procedures. Dr. Leape was a founding director of the National Patient Safety Foundation, the Massachusetts Coalition for the Prevention of Medical Error, and the Harvard Kennedy School Executive Session. He led the Institute for Healthcare Improvement's first Breakthrough Collaborative on Prevention of Adverse Drug Events. He was a member of the Institute of Medicine (IOM) Quality of Health Care in America Committee, which recently released its reports, To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century. Recent awards include the Distinguished Service Award of the American Pediatric Surgical Association (1997), the Robert Wood Johnson Investigator Award (1998), the Donabedian Award from the Medical Care Section of the American Public Health Association (1999), the Cheers Award from the Institute for Safe Medication Practices (1999), and the Pinnacle Award from the American Pharmaceutical Association (2001). Dr. Leape is a graduate of Cornell University and Harvard Medical School and trained in surgery at Massachusetts General Hospital and at Boston Children's Hospital.

Diann B. Uustal, EdD, is the founder and president of an educational consulting firm, Educational Resources in HealthCare, Inc. She is a facilitator of workshops and seminars in clinical ethics, professional caregiving issues, and values education at hospitals, colleges of nursing and medicine, and specialty nursing, medical, and other professional organizations. She also teaches a graduate course in healthcare ethics and is a professor at the University of Rhode Island. She received a bachelor's degree in nursing from the University of Rhode Island and a master's degree in nursing from the University of Massachusetts. She earned her doctorate in education, majoring in ethics and values in healthcare, at the University of Massachusetts. In 1994, Dr. Uustal completed a year's postdoctoral fellowship in clinical bioethics as a Visiting Fellow at the Kennedy Institute of Ethics at Georgetown University. She has authored numerous articles on healthcare values and ethics, professional issues in nursing, and caring for the caregiver. In addition, Dr. Uustal has published four books, most recently, Caring for Yourself--Caring for Others: The Ultimate Balance and Clinical Ethics and Values: Issues and Insights in a Changing Health Care Environment. Dr. Uustal also has co-edited Teacher Burnout, a book published by the National Education Association. She was a major consultant to the award-winning Concept Media film series "Ethics, Values and Health Care" and wrote the script for the film "Values Clarification."

The clinical, pathologic, and immunohistochemical features of a widely disseminated tumor with rhabdoid phenotype are described in nine infantsor = 3 months of age. Five neonates had tumor evident at birth, two of which had placental metastases. The average survival following diagnosis was6 weeks. None of the infants had an apparent primary tumor in either the kidney or brain. In four cases, the dominant mass involved the head and neck region, and in two cases, the primary mass was paraspinal. The histologic features were those of a high-grade, round cell neoplasm with abundant cytoplasm and containing cells with cytoplasmic filamentous inclusions. Immunohistochemical studies revealed polyphenotypic antigen expression. Genetic information was available from eight of nine cases. Karyotype analysis revealed abnormalities of chromosome band 22q11-12 in three of six tumors. Fluorescence in situ hybridization studies or molecular studies demonstrated 22q11.2 deletions in all five cases with available frozen tissue, two of which had translocations involving 22q by karyotype analysis. The similar clinical and pathologic findings in these rapidly fatal tumors in infants and the demonstration of abnormalities of chromosome 22q11 in a majority of the cases supports their histogenetic and nosologic relationship to the family of malignant rhabdoid tumors that typically occur in young children in several anatomic sites, including kidney, soft tissues, liver, and brain. Like neuroblastoma and rhabdomyosarcoma, malignant rhabdoid tumor can appear as disseminated disease at birth or shortly thereafter.

Barry M. Straube, MD, director of the Office of Clinical Standards and Quality and chief medical officer at the Centers for Medicare & Medicaid Services (CMS), oversees the CMS quality policy portfolio, including national coverage policies and quality standards for Medicare and Medicaid; quality measurement and public reporting; and the Quality Improvement Organization Program. Straube is senior advisor to the administrator on clinical and scientific policy. He received an AB degree from Princeton University and an MD degree from the University of Michigan Medical School. He completed an internal medicine residency at California Pacific Medical Center and served as a renal fellow at Tufts University-New England Medical Center. He is board certified in internal medicine and nephrology.

Background: Jejunoileal (JI) bypass was developed as a therapy for morbid obesity in the late 1960s but has since been abandoned because of a high rate of complications, including cirrhosis. The need for liver transplantation after JI bypass has been infrequent, with only four previous patients reported in the literature; however, because the time to develop symptomatic endstage liver disease after JI bypass may be quite long (25 years or more), the incidence of patients who will require liver transplantation may only now be increasing. Study Design: We reviewed our experience with JI bypass and liver transplantation in 380 consecutive adult patients since 1985. Results: Four patients underwent liver transplantation for cirrhosis after JI bypass, all within the last 48 months. The mean duration of time from JI bypass to transplantation was 22.3 years. All patients had complications, in addition to their liver disease, which were related to the JI bypass, which included nephrolithiasis, cholelithiasis, vitamin deficiencies, renal insufficiency, and d-lactic acidosis. One patient had the JI bypass taken down before transplantation, which precipitated acute liver and renal failure, necessitating urgent transplantation. One patient, who had the JI bypass taken down at the time of transplant, has developed recurrent morbid obesity, while the other three patients have not. The one patient who has not had the JI bypass taken down has not developed evidence of recurrent liver disease and is followed with monthly liver function tests and yearly biopsies. Conclusions: The incidence of patients who require liver transplantation after JI bypass may be on the increase. Take down of the JI bypass may precipitate acute liver failure in the cirrhotic patient. JI bypass should be accomplished either at the time of transplantation or if signs of liver dysfunction occur after transplantation. Liver transplant recipients can be at risk for recurrent obesity after takedown of the JI bypass. Transplantation for those patients with decompensated cirrhosis after JI bypass has demonstrated excellent early results.

The National Alliance for Health Information Technology (NAHIT) appointed Scott Wallace as its first president and CEO in 2003. NAHIT is an organization of 90 Leading healthcare associations, suppliers, vendors, hospitals, and healthcare systems committed tothe development of voluntary standards for health information technoLogy. Wallace previously was the principal owner of Great kes Capital, a financiaL, commerciaL, and business development consulting firm with a major focus in technology. Prior to starting Great Lakes, Wallace led several technoLogy-based companies. He served as president and CEO of PowerClip Co., a wireless products mpany; president and CEO of Eichrom Industries, an advanced materials and specialty chemical company; and vice president and general counsel for GCI, a venture capital fund. Wallace earned a juris doctorate from the University of Chicago Law School, a master's degree in business administration from the University of Chicago Graduate School of Business, anda bachelor's degree in economics from Duke University.

Linda Aiken, PhD MSN, is director of the Center for Health Outcomes and Policy Research and The Claire M. Fagin Leadership Professor of Nursing and Professor of Sociology at the University of Pennsylvania in Philadelphia. Dr. Aiken's other appointments at the University of Pennsylvania include senior fellow at the Leonard Davis Institute for Health Economics and research associate in the Population Studies Center. Before joining the University of Pennsylvania faculty in 1988, Dr. Aiken served as vice president of the Robert Wood Johnson Foundation. She is a member of the Institute of Medicine, a fellow of the American Academy of Arts and Sciences and of the National Academy of Social Insurance, a former president of the American Academy of Nursing, a distinguished fellow of the Academy for Health Services Research and Health Policy (now AcademyHealth), and a member of the Council on the Economic Impact of Health System Change. Dr. Aiken served on the Medicare Physician Payment Review Commission for 6 years and was a member of the 1982 Social Security Advisory Council and of President Clinton's National Health Reform Task Force. Her recent work, for which she received the Sigma Theta Tau International Clinical Research Award in 1999, has focused on accounting for variation in hospital patient outcomes in the United States, Canada, the United Kingdom, and Germany. Dr. Aiken received her bachelor's and master's degrees in nursing from the University of Florida, Gainesville, and her doctorate in sociology and demography from the University of Texas at Austin.

Bernard Rosof, MD MACP, is senior vice president for corporate relations and health affairs at the North Shore-Long Island Jewish Health System and clinical professor of medicine at New York University School of Medicine. Before assuming a full-time hospital position, Rosof was in the private practice of internal medicine and gastroenterology for 29 years. He has chaired committees and task forces in New York and for the Institute of Medicine, National Quality Forum, the American Medical Association (AMA), and various specialty societies. He has achieved national recognition for his contributions in the areas of healthcare quality and clinical practice guidelines and is the current chair of the Physician Consortium for Performance Improvement convened by the AMA. He is a member of the editorial board of the American Journal of Medical Quality and chair of the committee on quality assurance in office based-surgery for the Commissioner of Health of New York State. Rosof is a former member of the board of directors of the National Alliance of Autism Research and was instrumental in the development of the North Shore-Long Island Jewish Health System's Center for Autism. He is a master of the American College of Physicians and chair emeritus and president emeritus of the Board of Regents of the American College of Physicians.

Sr. Mary Jean Ryan, Franciscan Sister of Mary, is president/chief executive officer of SSM Health Care (SSMHC), one of the largest Catholic healthcare systems in the United States, with 23,000 employees and 5,000 affiliated physicians serving in 21 hospitals and 3 nursing homes. This year SSMHC became the first healthcare recipient of the Malcolm Baldrige National Quality Award. During her 16-year tenure, Sr. Mary Jean has emphasized three key themes: preservation of the earth's resources, valuing ethnic and gender diversity, and commitment to continuous quality improvement (CQI). She is co-author of CQI and the Renovation of an American Health Care System: A Culture Under Construction, published by ASQ Quality Press in 1997. Sr. Mary Jean has received numerous honors, including the Brotherhood/Sisterhood Award from the National Conference of Community and Justice; (one of) 20 Distinguished Women/St. Louis area; Governor's Quality Leadership Award (Missouri); (one of) 25 Most Influential Women in Business in St. Louis; and the Corporation that Makes a Difference Award from the International Women's Forum. She serves on a number of healthcare and local, state, and national boards. She received a master's degree in hospital and health administration from Xavier University in Cincinnati. She is a nurse and has been a Franciscan Sister of Mary for more than 40 years.

James P. Bagian, MD, is director of the Veterans Health Administration (VHA) National Center for Patient Safety (NCPS). With a focus on systems and an emphasis on “prevention not punishment,” NCPS is working to improve patient safety, prevent health care errors, and nurture a culture of safety throughout the 173 VHA medical centers. Previously, Dr. Bagian served as deputy director of the Regional and State Programs Division, Office of Mobile Sources, Environmental Protection Agency. From 1980 to 1995, Dr. Bagian served as a NASA astronaut. He took part in both the planning and provision of emergency medical and rescue support for the first six Space Shuttle flights. In 1986, Dr. Bagian served as an investigator for the Space Shuttle Challenger accident. A veteran of two space flights (STS-29 in 1989 and STS-40 in 1991), Dr. Bagian has logged more than 337 hours in space. Dr. Bagian is currently an adjunct assistant professor of military and emergency medicine at the Uniformed Services University of Health Sciences at F. Edward Herbert School of Medicine and also a clinical assistant professor of preventive medicine and community health at the University of Texas Medical Branch. He is a Colonel in the U.S. Air Force Reserve where he is a pararescue flight surgeon with the 920th Air Rescue Group. He has received the American Medical Association's Nathan S. Davis Award for outstanding public service in the advancement of public health. The NCPS received the 2001 Innovations in American Government Award given by the Institute for Government Innovation at the John F. Kennedy School of Government of Harvard University. The NCPS was the only federal organization to be so identified in 2001.