Chair Position Research Articles

AOA Critical Issues: The Status of the Vice Chair Position in Orthopaedic Surgery Departments in 2023.

The vice chair position in orthopaedic surgery departments has become increasingly prevalent over the last 10 years. Prior to this development, there were few, if any, vice chairs to support the chairperson position. The vice chair role has increased in importance as a result of increasing practice size and the increasing complexity of the health-care environment. The goal of this review was to summarize the current status of the vice chair position within orthopaedic surgery departments and to share the variety of vice chair roles that exist today.

Anchorless Arthroscopic Transosseous Rotator Cuff Repair.

Rotator cuff repair techniques have evolved over time. The original techniques were open procedures, then surgeons adopted arthroscopic repair procedures with anchors and implants. Today, rotator cuff repair has evolved to be performed as an arthroscopic transosseous technique that is again performed without the use of anchors. In this video, the 5 essential steps of arthroscopic transosseous repair will be demonstrated. (1) Position the patient in either the beach chair or lateral decubitus position. (2) Utilize 4-portal arthroscopy, which allows a consistent vantage point while having 3 other portals for instrumentation. (3) Perform just enough bursectomy to expose the rotator cuff. (4) Anatomically reduce the rotator cuff anatomy where possible. (5) Triple-load the transosseous tunnels with high-strength sutures in order to maximize the biomechanical strength of the repair. Alternative surgical techniques include open rotator cuff repair and single and double-row rotator cuff repair using anchors. The goal of any rotator cuff repair is to anatomically restore the rotator cuff. The fundamental principles include a strong initial biomechanical fixation, cuff footprint anatomy restoration, and maximization of biological factors to promote healing of the rotator cuff. Rotator cuff repair was originally performed as an open procedure, which allows for direct visualization of the tear and repair; however, open repair requires some level of deltoid splitting, which can potentially affect postoperative early mobilization. Single-row and double-row cuff repairs can both be performed arthroscopically. Proponents of the double-row procedure prefer that technique for its footprint restoration and stronger biomechanical fixation; however, the double-row procedure can result in overtensioning of the repair and can lead to medial-based rotator cuff failures. Proponents of the single-row procedure prefer that technique for its ease of operation, fewer implants, lower cost, and low repair tension; however, the single-row procedure fixes the tendon at a single point, limiting the repaired footprint, and can be associated with lower fixation strength. The arthroscopic transosseous rotator cuff repair achieves all of the above goals as it provides strong initial fixation and anatomic footprint restoration, which allows maximal patient biology for healing. There are numerous studies that can attest to the success of arthroscopic transosseous repair. Some of the benefits include decreased health-care costs and postoperative pain levels. In a 2016 study of 109 patients undergoing arthroscopic transosseous rotator cuff repair, Flanagin et al. reported a mean American Shoulder and Elbow Surgeons (ASES) score of 95 and a failure rate of 3.7% at mid-term follow-up1. Similarly, in a study comparing transosseous repair to transosseous equivalent repair, Srikumaran et al. reported that patients undergoing transosseous repair had a mean ASES score of 92 and a failure rate of 14%, with no significant differences between treatment groups2. Finally, in a study assessing the results of arthroscopic transosseous rotator cuff repair at >10 years postoperatively, Plachel et al. reported a mean ASES score of 92 and a failure rate of 27%3. Compared with conventional rotator cuff with anchors, the transosseous cuff repair can lead to cut-out of the repair sutures from the bone.Use a 4-portal arthroscopy technique, which will help the surgeon visualize all tear configurations while instrumenting them.Perform just enough bursectomy, in order to preserve the growth factors for cuff healing.Take care to minimize tuberosity trauma as a result of burring.Prepare the transosseous tunnels with a wide bone bridge.Load each tunnel with 3 high-strength sutures in order to maximize repair strength.Restore the rotator cuff footprint to facilitate tissue healing. ASES = American Shoulder and Elbow SurgeonsRCR = rotator cuff repairATRCR = arthroscopic transosseous rotator cuff repairARCR = arthroscopic rotator cuff repairPDS = polydioxanone sutureROM = range of motionSSV = Subjective Shoulder ValueFF = forward flexionOR = operating roomFU = follow-up.

Gender and Pathways to Leadership in Academic Anesthesiology: A Qualitative Content Analysis of US Chairpersons' Curricula Vitae.

Women are underrepresented in medicine and academic anesthesiology, and especially in leadership positions. We sought to characterize career achievement milestones of female versus male academic anesthesiology chairs to understand possible gender-related differences in pathways to leadership. We conducted a retrospective observational cross-sectional analysis. In November 2019, curricula vitae (CVs) were requested from then-current members of the US Association of Academic Anesthesiology Chairs. Data reflecting accomplishments up to the time of chair appointment were systematically extracted from CVs and analyzed using a mixed methods approach with qualitative content analysis supplemented by descriptive statistics and bivariate statistical testing. Missing data were not imputed. Seventy-two CVs were received from eligible individuals (response rate 67.3%). The respondent sample was 12.5% women (n = 9), 87.5% men (n = 63), and no transgender or nonbinary people; this is similar to the known gender balance in anesthesiology chairs in the United States. No statistically significant differences in objective markers of academic achievement at the time of chair appointment were evident for female versus male chairs, including time elapsed between the first faculty appointment and assumption of the chair role (median 25 vs 18 years, P = .06), number of publications at the time the chair was assumed (101 vs 69, P = .28), or proportion who had ever held a National Institutes of Health (NIH) grant as principal investigator (44.4% vs 25.4%, 0.25). Four phenotypes of career paths were discernible in the data: the clinician-administrator, the educator, the investigator, and the well-rounded scholar; these did not differ by gender. Female chairpersons who were members of the Association of Academic Anesthesiology Chairs in the United States demonstrated similar patterns of academic achievement as compared to male chairpersons at the time the position of chair was assumed, suggesting that they were equally qualified for the role as compared to men. Four patterns of career achievements were evident in the chairperson group, suggesting multiple viable pathways to this leadership position.

The landscape of penile cancer research in Germany and Austria: a survey among professors in academic centers holding chair positions and results of a literature search.

Research on penile cancer (PeCa) is predominantly conducted in countries with centralized treatment of PeCa-patients. In Germany and Austria (G + A), no state-regulated centralization is established, and no information is available on how PeCa-research is organized. Current research competence in PeCa was assessed by a 36-item questionnaire sent to all chairholders of urological academic centers in G + A. Based on PubMed records, all scientific PeCa-articles of 2012-2022 from G + A were identified. Current research trends were assessed by dividing the literature search into two periods (P1: 2012-2017, P2: 2018-2022). A bibliometric analysis was supplemented. Response rate of the questionnaire was 75%, a median of 13 (IQR: 9-26) PeCa-patients/center was observed in 2021. Retrospective case series were conducted by 38.9% of participating clinics, while involvement in randomized-controlled trials was stated in 8.3% and in basic/fundamental research in 19.4%. 77.8% declared an interest in future multicenter projects. 205 PeCa-articles were identified [median impact factor: 2.77 (IQR: 0.90-4.37)]. Compared to P1, P2 showed a significant increase in the median annual publication count (29 (IQR: 13-17) vs. 15 (IQR: 19-29), p < 0.001), in multicenter studies (79.1% vs. 63.6%, p = 0.018), and in multinational studies (53% vs. 28.9%, p < 0.001); the proportion of basic/fundamental research articles significantly declined (16.5% vs. 28.9%, p = 0.041). Four of the top-5 institutions publishing PeCa-articles are academic centers. Bibliometric analyses revealed author networks, primary research areas in PeCa, and dominant journals for publications. Given the lack of centralization in G + A, this analysis highlights the need for research coordination within multicenter PeCa-projects. The decline in basic/fundamental research should be effectively addressed by the allocation of funded research projects.

Patient positioning on the operating table and patient safety: A systematic review and meta-analysis.

To identify occurrence of harmful incidents related to patient positioning on operating table. Systematic review and meta-analysis. Eight databases including Ovid, Medline, Embase, CINAHL, the Cochrane Library, Epistemonikos, Scopus, Web of Science and Google Scholar were systematically searched from the inception of the databases to August 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram depicting the flow information. The Cochrane Risk of Bias Tools were used to assess the risk of bias. Risk of harm with 95% confidence interval (CI) was estimated for each included study, and an overall risk was calculated using meta-analysis. Of the 22 included reports, two were randomized controlled trials (RCTs), five had a prospective cohort design, three had a cross-sectional design, and 12 were register-based studies. Intraoperative peripheral nerve injuries, perioperative pressure ulcers, musculoskeletal injuries, vascular injuries, postoperative pain and eye injuries were related to supine, lithotomy, Trendelenburg, prone and beach chair positioning. Overall risk of any harm was estimated as 0.2%. Studies with patients placed in prone positioning (8 study samples) had the highest risks of harm varying from 0.19 to 0.81, with an overall risk of 0.33. Meta-analysis of the two RCTs showed higher risk of chemosis with head-down positioning than with head in neutral position (overall relative risk = 1.64; 95% CI: [1.25, 2.14]). Harmful incidents related to patient positioning occur and consequences can be severe. The operating room teams should be aware of the harms and prevent and treat them seriously. This review underlines that research is sparse on patient positioning on operating table and harmful incidents. There is a need for high-quality, well-designed studies that focus on harmful incidents and prevention of harm related to patient positioning. No patient or public contribution, as this is a review of previous research.

Lead Independent Director: Impact on Firm Performance and Financial Misstatements

This paper examines whether the presence of a lead independent director improves firm performance and reduces financial misstatements. Using a sample of Fortune 1000 companies in the year 2013, we find that the effect of lead independent directors on firm performance hinges on CEO –Chair duality. For companies with CEO-Chair duality, the existence of a lead independent director is positively associated with improved firm performance as measured by Tobin’s Q. In contrast, we do not find a similar association for companies separating the CEO and board chair positions. In addition, we do not find an association between the existence of a lead independent director and the likelihood of misstatements. These results suggest that the existence of a lead independent director helps improve a company’s corporate governance.

Does institutional holders’ approval really matter? An examination of Israel’s binding vote on CEO compensation, from directors’ point of view

This study examines the implications of mandatory shareholder approval for chief executive officer (CEO) compensation in Israel, following the “say-on-pay” (SOP) framework. Through the utilization of a binding voting framework, shareholders evaluate the effectiveness of CEO compensation structures. A survey involving 106 Israeli directors occupying diverse board positions, including external, independent, regular, and chair positions, reveals that external directors demonstrate a greater appreciation for institutional votes. This highlights their acknowledgment of institutional perspectives and underscores the critical significance of fostering effective communication between boards and institutional stakeholders to strengthen corporate governance frameworks. The study emphasizes the pivotal role of dialogue in enhancing governance structures through a nuanced examination of challenges in executive compensation governance

A Single-Portal Arthroscopic Technique for Type II Slap Lesions in the Beach Chair Position

The options for surgical treatment of an anterior labrum lesion have become extensive. Arthroscopic treatments are widely used as an improved minimally invasive option with a quick recovery. Arthroscopic treatment of the anterior glenoid labrum generally requires the creation of two working portals. However, arthroscopic treatment through a single anterior portal is still successful. Our single-portal technique avoids interference between instruments inserted through the two working portals and minimizes postoperative scarring, pain, and reduction in range of motion. The purpose of this article was to describe our single-portal arthroscopy technique to repair the anterior glenoid labrum.

Navigating the white waters with servant leadership

No one ever promised that the university department chair position was going to be an easy one. On any given day, the chair has the responsibility to make a multitude of decisions, with each decision having the potential to impact the department either positively or negatively. Consequently, effective department leaders have developed their own special skill set that helps them to make the right decisions at the right times, relying on research and data to support their decisions.

Women physicians in academic pathology leadership.

To evaluate the gender composition of departmental chairs and program leadership of Accreditation Council for Graduate Medical Education-accredited pathology residencies and American Board of Pathology-certified subspecialty fellowships across the United States. In this cross-sectional analysis, we examined the gender of individuals holding leadership positions in academic pathology in the United States. Using publicly available online data, 2 authors independently coded perceived gender (ie, man/woman/other) with 100% concordance. In 144 pathology residency programs, more women hold residency program director positions (52.1% [75/144]). Among 11 pathology subspecialties, women overall hold fewer fellowship program director positions (45.0% [212/471]). Among the residency-associated pathology department chair positions identified, women hold fewer positions (31.8% [42/132]). There is some geographic variation in pathology leadership gender composition when stratified using US Census regions. Women in academic pathology departments are well represented in residency and overall fellowship program leadership but are underrepresented in department chair and certain pathology subspecialty leadership positions. The disproportionate number of women in department chair positions is observed across medical specialties, highlighting the need for improved gender equity among high-level academic medicine positions.

Sex disparities in parenteral and enteral nutrition societies' leadership worldwide: a 20-year retrospective analysis

BackgroundDespite advancements in the global dialog surrounding sex and gender equity, an important gap persists with women markedly underrepresented in major roles within health care leadership. ObjectivesWe examined the extent of women’s representation in prominent positions within parenteral and enteral nutrition (PEN) societies worldwide over a span of 2 decades. DesignThis retrospective analysis explored the sex distribution of society chairs, conference presidents, and editor-in-chief positions across 64 PEN societies between 2003 and 2022. Additionally, data on the first and last authors of endorsed clinical guidelines were collected from the 2 leading societies. ResultsOver the past 20 y, women held society chair positions in 34.4% of cases. The representation shifted from 30% during the decade from 2003 to 2012 to 40.5% from 2013 to 2022. Throughout these years, the numbers consistently ranged from 0 to 10; however, the median shifted upward from 1 during the first decade to 4 in the subsequent decade (P = 0.04). Of 420 congress presidencies, ∼30% were women. In endorsed guidelines, women were the first authors in 27.1% of cases (P < 0.001) and the last in 28.9% (P < 0.001) compared with men. Of the 123 journal editor-in-chief positions, women occupied 23 (18.7%). ConclusionOver the last 2 decades, women have been consistently underrepresented in prominent leadership roles in PEN societies globally. Although there has been a noticeable shift toward more women in chair positions, true sex equality remains elusive. Moreover, sex disparities are even more pronounced in positions, such as conference presidents, authors of major guidelines, and editors-in-chief of society-affiliated journals. These data underscore the pressing need to enhance efforts toward sex equality across these domains.

Racial and ethnic diversity of National Comprehensive Cancer Network (NCCN) committee members.

81 Background: Racial and ethnic disparities are pervasive in cancer care including within the workforce and in leadership. A diverse workforce can increase patient satisfaction, treatment adherence, and improve optimal care in underserved populations. NCCN committees set the standard of care for cancer diagnosis, treatment, and survivorship, but little is known about the diversity of committee members. Methods: All NCCN organ-specific treatment guidelines from 2022 were reviewed; demographics including degree and leadership role were documented. Photographs were collected via online search and race, ethnicity, and gender were determined using a combination of facial recognition software and manual review. Academic rank and H-index were collected from professional profiles and Scopus, respectively. Multivariate analysis (MVA) assessed diversity of committees of the deadliest cancers in Black and Hispanic patients (breast, cervical, colon, gastric, gastrointestinal, hepatobiliary, multiple myeloma, non-small cell lung, pancreatic, prostate, rectal, small cell lung, and uterine cancers). Results: 1,172 unique members were found, representing 62 NCCN committees (median: 33.5 members; range: 24-40). Photographs could not be identified for 3, leaving 1,169 as the final sample. NCCN members were 74% White, 24% Asian, 2% Black, and 3% Hispanic. Members were mostly male (62%) and senior faculty (71%). Women were more likely to be junior faculty (25% vs 37% men, p&lt;0.001) with lower median H-Index (20 vs 30 men, p&lt;0.001). Less than half of committees (42%) had at least 1 Black member; most (76%) had at least 1 Hispanic member. The majority (82%) had at least 1 Black or Hispanic member. Of 63 Chairs, most were White (81%) and the remainder were Asian (19%). Of 59 Vice Chairs, 80% were White, 14% were Asian, and 7% were Black. There were no identified Hispanic committee Chairs or Vice Chairs. Committees for the deadliest cancers in Black and Hispanic patients were no more likely to have a respective Black (OR=1.25, 95%CI 0.58-2.71, p=NS) or Hispanic (OR=1.08, 95%CI 0.59-1.97, p=NS) committee member. On MVA, being female (OR=1.27; 95%CI: 1.01-1.58; p=0.038) and having a higher H-index (16-30: OR=1.41; 95%CI: 1.03-1.94; p=0.033; &gt;30: OR=1.83; 95%CI: 1.32-2.55; p&lt;0.001) were associated with increased odds of serving on a committee of a cancer deadliest in Black and Hispanic patients; neither race nor ethnicity increased the odds of serving on these committees. Conclusions: NCCN committee members in 2022 were predominantly White and Asian, with few Chair positions held by Black or Hispanic members. Less than half of committees had any Black member and committees providing guidelines for cancers with high mortality rates in Black and Hispanic patients were no more likely to have diverse members. Future efforts should focus on both diversifying the physician workforce and within leadership positions in oncology.

Path to success: female leaders in German neurosurgery

Despite advances in gender equality, only 6% of German neurosurgical departments are currently led by women. With regard to their pioneering work and the importance of their role model effect, we aimed at reporting on the career pathways of the present and former female chairs of neurosurgical departments in Germany. We approached current and former female chairs in German neurosurgery and gathered descriptive information on their ways into leadership positions through structured interviews. Data were obtained from 16/22 (72.7%) female neurosurgical chairs, aged between 44 and 82 years. They completed their training within 6.5 ± 0.6 years, and it took them further 14.5 ± 5.9 years between training completion and chair acquisition. Having obtained their chair positions between 1993 and 2020, six (37.5%) of them have retired or changed career tracks. Of ten (62.5%) chairs still practicing, two are directors of university departments. Twelve (75.0%) hold professorships. Nine chairs (56.3%) are married, eight (50.0%) having children. Five chairs reported having experienced gender-based discrimination. Twelve had a male mentor or role model, two had a female role model, while only one had a female mentor. This study characterizes the to date small number of female neurosurgical chairs in Germany and their paths to neurosurgical leadership positions. In future, these should become historical in order to perceive the presence of women in leadership positions as self-evident normality, reflecting our society. However, further analyses comparing paths of both female and male neurosurgical chairs are necessary to explore gender-based differences in achieving neurosurgical leadership positions.

Ophthalmology Faculty Diversity Trends in the US

Enhancing the diversity of ophthalmologists can potentially contribute to diminishing disparities in eye care. To investigate longitudinal trends in the representation of individuals underrepresented in medicine (URiM) and women among ophthalmology faculty compared with other specialties and to assess disparities between ophthalmology faculty demographic characteristics and the US population. In this cross-sectional study, a comprehensive analysis of Association of American Medical Colleges Faculty Roster data between 2000 and 2021 was conducted, using data from the US Medical School Faculty report on 56 438 ophthalmology faculty members. The data set was used to differentiate ophthalmology faculty members by gender, rank, and designation as a URiM individual. Outcome measures included changes in URiM and non-URiM faculty proportions, faculty rank, gender, department chair positions, and the US population between 2000 and 2021. A total of 56 438 ophthalmology faculty members (37 511 men [66.5%]) were included in the study. The number of ophthalmology faculty increased from 1820 in 2000 to 3151 in 2021. Across all years, URiM female faculty represented 3.1% of ophthalmologists (1733 of 56 438), while URiM men accounted for 3.5% (1983 of 56 438). Overall, non-URiM men constituted 63.0% of ophthalmologists (35 528 of 56 438), and non-URiM women accounted for 30.5% (17 194 of 56 438). The proportion of URiM male faculty remained stable from 2000 to 2021 (63 of 1820 [3.5%] vs 104 of 3151 [3.3%]), with a small increase in URiM women faculty at junior faculty positions (2000, 40 of 1820 [2.2%]; 2021, 129 of 3151 [4.1%]; difference, 1.9% [95% CI, 0.9%-2.9%]). Proportions of non-URiM men decreased from 71.2% (1295 of 1820) in 2000 to 55.3% (1743 of 3151) in 2021 (difference, 15.8% [95% CI, 13.1%-18.6%]) and proportions of non-URiM women increased from 23.2% (422 of 1820) in 2000 to 37.3% (1175 of 3151) in 2021 (difference, 14.1% [95% CI, 11.5%-16.7%]). In terms of faculty rank, there were increases in representation of women from 2000 to 2021 at assistant professor (from 11.2% [203 of 1819] to 19.7% [622 of 3165]; difference, 8.5% [95% CI, 6.5%-10.5%]), associate professor (from 4.6% [83 of 1819] to 8.6% [271 of 3165]; difference, 4.0% [95% CI, 2.6%-5.4%]), and professor levels (from 2.8% [51 of 1819] to 7.1% [223 of 3165]; difference, 4.3% [95% CI, 3.9%-6.1%]). URiM representation remained stable at most ranks. Compared with other specialties, ophthalmology had among the lowest percentage change in URiM faculty. The expansion of ophthalmology's URiM faculty representation was less than one-third that of the diverse US population. These findings highlight substantial growth in ophthalmology faculty and an increase in women's representation across several faculty ranks. However, URiM representation has remained largely unchanged, despite an increase at the associate professor level. This finding emphasizes the need for continued efforts to enhance diversity in academic ophthalmology.

Racial, Ethnic, and Gender Diversity Among Academic Surgical Leaders in the US

Surgical department chairs remain conspicuously nondiverse despite the recognized importance of diverse physician workforces. However, the extent of diversity among non-chair leadership remains underexplored. To evaluate racial, ethnic, and gender diversity of surgical department chairs, vice chairs (VCs), and division chiefs (DCs) in the US. For this cross-sectional study, publicly accessible medical school and affiliated hospital websites in the US and Puerto Rico were searched from January 15 to July 15, 2022, to collect demographic and leadership data about surgical faculty. Two independent reviewers abstracted demographic data, with up to 2 additional reviewers assisting with coding resolution as necessary. In all, 2165 faculty were included in the analyses. Proportions of racial, ethnic, and gender diversity among chairs, VCs, and DCs in general surgery and 5 surgical specialties (neurosurgery, obstetrics and gynecology, ophthalmology, orthopedics, and otolaryngology). A total of 2165 faculty (1815 males [83.8%] and 350 females [16.2%]; 109 [5.0%] African American or Black individuals; 347 [16.0%] Asian individuals; 83 [3.8%] Hispanic, Latino, or individuals of Spanish origin; and 1624 [75.0%] White individuals as well as 2 individuals [0.1%] of other race or ethnicity) at 154 surgical departments affiliated with 146 medical schools in the US and Puerto Rico were included in the analysis. There were more males than females in leadership positions at all levels-chairs (85.9% vs 14.1%), VCs (68.4% vs 31.6%), and DCs (87.1% vs 12.9%)-and only 192 leaders (8.9%) were from racial or ethnic groups that are underrepresented in medicine (URiM). Females occupied more VC than chair or DC positions both overall (31.6% vs 14.1% and 12.9%, respectively) and within racial and ethnic groups (African American or Black females, 4.0% VC vs 1.5% chair and 0.6% DC positions; P < .001). URiM individuals were most commonly VCs of diversity, equity, and inclusion (DEI, 51.6%) or faculty development (17.9%). Vice chairs of faculty development were split equally between males and females, while 64.5% of VCs for DEI were female. All other VCs were predominantly male. Among DC roles, URiM representation was greatest in transplant surgery (13.8%) and lowest in oral and maxillofacial surgery (5.0%). Except for breast and endocrine surgery (63.6% female), females comprised less than 20% of DC roles. Nearly half of DCs (6 of 13 [46.2%]) and VCs (4 of 9 [44.4%]) had no female URiM leaders, and notably, no American Indian, Alaska Native, or Native Hawaiian or Other Pacific Islander individuals were identified in any surgical leadership positions. While it is unclear whether promotion from VC to chair or from DC to chair is more likely, these findings of similar gender distribution between chairs and DCs suggest the latter and may partially explain persistent nondiversity among surgical chairs. Female and URiM surgical leaders are disproportionately clustered in roles (eg, VCs of DEI or faculty development) that may not translate into future promotion to department chairs.

CEO as board chair in listed family firms: A test of the performance effects during an economic crisis

AbstractFamily firms often opt for a combined CEO and board chair positions, yet the implications of such leadership structure on firm performance remain a subject of scholarly debate. We introduce the socioemotional wealth (SEW) perspective as a unifying framework that bridges the divergent views of stewardship and agency theories. We argue that the effects of CEO duality on performance are contingent upon the balance between extended and restricted SEW priorities. Drawing on a sample of listed companies on the Milan Stock Exchange between 2003 and 2015, our empirical analysis reveals that listed family firms derive greater benefits from CEO duality compared to their non‐family counterparts. Moreover, our findings demonstrate that such leadership structure renders the highest performance benefits in listed family firms when the CEO–chair is not a family member, particularly during periods of economic crisis.

Anaesthesia Management of Case of Atrial Septal Defect (Cardiac Disease) for Proximal Humerus Fracture (Non-Cardiac Case)

Atrial Septal Defect is most common congenital developmental acyanotic cardiac anomaly. There is left to right shunt of blood in normal compensated state. In decompensated state, the shunt is reversed and flow is from right to left side causing heart failure and thrombo-embolic event. Here, we report a case of Humerus fracture with large ASD, managed under General Anaesthesia with Interscalene block without any deleterious effects like Venous Air Embolism, Spontaneous Reversal of Shunt etc. As patient was in Beach chair position.

Direct and spillover effects of board gender quotas: Revisiting the Norwegian experience

AbstractBuilding on the Norwegian case, this study examines the long‐term implications of board gender quotas on the advancement of gender diversity in managerial leadership. Previous research has indicated that, aside from the board, the quota had limited impact on achieving this objective. However, these studies have narrowly focused on the spill‐over effects of the quota, primarily concentrating on the positions of CEO and Chair. The findings of this study reveal contrasting effects of the board gender quota on the gender composition of the board and the executive committee of the board. Consequently, Norwegian companies have increased the representation of women on their boards, as mandated by the law, while simultaneously experiencing a reduction in the presence of female executive directors. Moreover, the strength of both opposing effects has diminished over time. In addition to the board of directors, the quota has not influenced the promotion of gender diversity at other managerial levels. Furthermore, our study suggests that the quota has led to a decrease in the average tenure and level of independence of the boards, although it has not affected the qualifications of board members.

Female chairs on the boards of European National Sports Federations: a comparative study

Purpose This study aims to explore the impact of board size, board gender diversity and federation age on the likelihood of having a female chair in National Sports Federations (NSF). Design/methodology/approach A quantitative methodology compares 300 sports boards in five countries (Italy, Portugal, Spain, Turkey and the UK), using data collected from NSF’s websites. Findings The board size and federation age have no significant impact on having a female board chair when the countries and the percentage of female directors are included in the model. When the number of women is measured in absolute value rather than in relative terms, the only variable that predicts a woman chair is the country. When the model does not include country differences, the percentage of female directors is key in predicting a chairwoman, and when the number of women is used as a variable instead of the percentage, a board’s smaller size increases the odds of having a chairwoman. Research limitations/implications There are some limitations to this study which we believe provide useful directions for future research. Firstly, the authors have not considered the role of gender typing in sports activities which explains the extent that women participate in specific sports (Sobal and Milgrim, 2019) and the related perception of such sports in society. The social representation of sports activities classified as masculine, feminine or gender-neutral can hypothetically influence women’s access to that specific federations’s leadership. The authors included the country factor only partially, as a control variable, as the social representation of sports usually goes beyond national boundaries. Practical implications This study has implications for sport policymakers and stakeholders, and for institutions such as the IOC or the European Union that implement equality policies. If the aim is to increase female presence in the highest position of a sports board and to achieve gender equality more generally, other policies need to be implemented alongside gender quotas for the sports boards, namely, those specifically related to the recruitment and selection of the sports board chairs (Mikkonen et al., 2021). For example, given the implications of critical mass and its ability to increase more female’s engagement then the role of existing chairs acting as mentors and taking initiative in this objective may be warranted. Furthermore, attention should be paid to the existing gender portfolio of each board and its subsequent influence on recruiting a female chair, regardless of the organization’s age. Knoppers et al. (2021) concluded that resistance to gender balance by board members is often related to discriminatory discourses against women. The normalization of the discourses of meritocracy, neoliberalism, silence/passivity about the responsibility of structures and an artificial defence of diversity emphasise that equality should not only be determined by women (Knoppers et al., 2021). Social implications When countries are included in the model, the results suggest that the social representation of a female board member is different from that of a female board chair. Originality/value The originality of the study is that it shows the factors that constrain women taking up a chair position on NSFs. Theoretically, it contributes to existing literature by demonstrating how a critical mass of females on boards may also extend to the higher and most powerful position of chair.

Audit committee accounting financial expertise and stock price crash risk

This paper examines whether the accounting financial experts (hereafter, AFEs) among audit committee (hereafter, AC) members and the AFEs' specific types of expertise affect future firm-specific stock price crash risk. Using a Korean sample of 2142 firm-year observations, we classify AFEs into four specific types: AC members with auditing, academic, practical, or supervisory expertise. We find that AC accounting financial expertise in general, and AFE with auditing and supervisory expertise in particular, are likely to reduce firm-specific crash risk. In addition, we provide evidence that the interaction between AC members with different types of expertise has a significant effect on the stock price crash risk by utilizing synergies between them. Furthermore, our findings are more pronounced for firms with higher financial reporting opacity, higher information asymmetry, and the presence of accounting financial expertise in the AC chair position, and are robust to alternative research designs. Overall, our results highlight the roles of different types of AC accounting financial expertise in preventing crashes in stock price.