Monday, July 27, 2009

Academic Debt: A Mind-Numbing High-Wire Act

I have been tracking the effects of the financial crisis on institutions of higher education in my post dated Dec. 9, 2008. The other day, I was reading about the struggle for survival of the country's largest lender to small and mid-sized businesses CIT Group Inc. Reuters has reported extensively on this case. The last update was posted on Jul. 24, 2009.  I began to wonder whether CIT's potential bankruptcy may affect academic institutions, about their debt load and their ratings.

Last September Commonfund Short Term Fund, a major investment fund for colleges and universities, was forced to close suddenly. The investors were left scrambling to recoup their money and Moody's issued a report on their credit worthiness in October. This report can be downloaded here. All assessed institutions maintained their excellent ratings.

However, some universities had borrowed enormous amounts of money, using self-liquidity backed VRDO/Commercial Paper. A Variable Rate Demand Obligation (VRDO) constitutes a debt security, such as a bond, with variable interest rates. A Commercial paper (CP) consists of unsecured promissory notes issued to meet short-term obligations, e.g. payroll. Both financial instruments provide the issuer with short-term liquidity.

The University of Michigan led Moody's list with $1,121,300,000.-. Among private research universities, Emory University and Vanderbilt University topped the list with $1,006,451,000.- and $646,135,000.-, respectively. Vanderbilt University kept borrowing heavily in the first half of this year. According to a Reuters report posted Feb. 23, the university issued $250 million in taxable notes. The post also lists $575.8 million in outstanding fixed-rate revenue bonds, $338.2 million in outstanding variable-rate revenue bonds, and $675 million in commercial paper. A Reuters post dated Mar. 9, 2009, reports that the university sought the issue of another $330 million in fixed-rate revenue bonds. Fitch Ratings assigned these issues 'AA'.

According to the Princeton Review, about 6,400 students are currently enrolled at Vanderbilt University. The university would need seven years to fulfill the outstanding financial obligations listed above from enrollment alone, provided all students paid full price, that is approximately $50,000.- per academic year.  This calculation does not include interests. In the face of the economic downturn and the associated losses in endowment, the scale of borrowing appears mind-numbing.


  • According to Stephanie Strom's report with the title "Nonprofits Paying Price for Gamble on Finances" in The New York Times yesterday,  Harvard University and Yale University had issued tax-exempt bonds for 2.5 and 1.6 billion dollars, respectively, already at the end of fiscal year 2007 (09/24/09).
  • The accuracy of risk assessments by the major rating agencies has come under severe scrutiny lately. Rachelle Younglai reports in her post with the title "Moody's secretive nature described to Congress" dated Sep. 30, 2009, on Reuters that an investigative congressional committee was less than impressed. It should be noted that the rating agencies rely heavily in their judgment on the financial information provided by the rated entities (10/01/09).
  • Compared with Vanderbilt University, Yale University has borrowed substantially more. The university disclosed in its annual report for the fiscal year ending June, 2008, that it possessed 3.1 billion dollars in outstanding bonds and notes. However, the value of Yale's endowment for that year is listed at 23.0 billion dollars, whereas Vanderbilt's endowment hovered around 3 billion dollars at that time (10/16/09).
  • According to Dan Wilchins and Elinor Comlay's exhaustive report entitled "CIT bankcruptcy reassigned after recusal" on Reuters today,  CIT Group Inc has filed for bankruptcy. Michael de la Merced provides a detailed chronology of events entitled " CIT to test Speed of Bankruptcy Court" for The New York Times (11/01/09).
  • Mega-universities may suffer from huge campuses and high student to teacher ratios. However, some possess a great advantage in the current economic situation. That is, their endowments contribute less to total revenue than the endowments at private colleges and universities. Hence, the losses in revenue they incurred because of the financial crisis rendered their budgets less vulnerable. Similar to numerous private institutions, the endowment of Ohio State University (OSU) in Columbus, Ohio, lost 30 percent of its value since 2007 (OSU endowed funds management brochure). However, the income from endowment at OSU contributes just about as much as student fees and less than a fifth to the total budget of 4.35 billion dollars (OSU statistical summary). The loss in endowment could, therefore, be absorbed with minor disruptions of spending. According to a Reuters business wire release dated  Jan. 7, 2009. Fitch Ratings reports OSU's  outstanding bonds at 753.3 million dollars. The university could repay this amount with one year's income from student fees (11/05/09).
  • For-profit healthcare providers apparently did well in the past year. Some flush with cash are prepared to acquire financially distressed not-for-profit hospitals. Listen to yesterday's interview of Columbia/HCA's CEO Richard M. Bracken by National Public Radio's WPLN in a segment entitled "HCA Earnings Soar, Acquiring Struggling Non-Profits Emerges as Growth Option". I recall hearing similar pronouncements a dozen years ago, when then CEO Richard L. Scott unleashed a similar wave of acquisitions. After such take overs, teachers and basic scientists may quickly become an endangered species as the fate of Allegheny University of  Health Sciences, a merger of Hahnemann University and Medical College of Pennsylvania, so aptly illustrates (11/06/09).
  • In the wake of the financial crises and the ensuing restructuring of private research universities, leaders of medical schools and teaching hospitals are leaving their posts. Eric Neilson, M.D., the Chairman of the Dept. of Medicine at Vanderbilt University, with roughly 650 faculty members the largest department of the medical school, stepped down a month ago and has been replaced by an in-house successor. Leslie Hast reports on Neilson's achievements in her post entitled "Neilson reflects on tenure as Medicine chair" in the REPORTER on Mar. 26, 2010. Further retirements and departures of division chiefs can be anticipated. The Chairman of the Dept. of Biochemistry, who lauds Neilson's accomplishments in Hast's article, just announced that he will vacate his chair at the end of June according to Bill Snyder's article entitled "Waterman to end 18 fruitful years as Biochemistry chair" in the same issue of the REPORTER (03/30/10).
  • The head of Vanderbilt University's Division of Hematology/Oncology David Johnson, M.D., announced his departure. The director of the Blood & Marrow Transplant Program Friedrich Schüning, M.D., will leave his post shortly (04/23/10).
  • The chairman of Vanderbilt's Department of Microbiology and Immunology stepped down. In the two years since E. Gordon Gee left his post as chancellor of Vanderbilt University, at least six Medical School directorships and chairs have been relinquished. None were replaced with new hires. As Kathy Whitney reports in her article for the REPORTER with the title "Spring Faculty Meeting provides updates on programs, initiatives" dated May 7, 2010, the vice chancellor for Health Affairs and dean of Vanderbilt University School of Medicine emphasized in his Spring faculty meeting address that the School of Medicine and the Medical Center are faring “very, very well as we rebuild our savings following the recession (05/13/10).”
  • According to Elizabeth Latt's post for Vanderbilt News with the title "Vanderbilt Board elects Mark Dalton to succeed Martha Ingram as chairman in 2011" dated Apr. 23, 2010, industrialist Martha Robinson Rivers Ingram is stepping down from her post as chairman of Vanderbilt University's Board of Trust. She will be replaced within a 12-month transition by co-chairman and CEO of Tudor Investment Corp. Mark F. Dalton (07/05/2010).
  • According to Jeff Lockridge's report in today's Tennessean entitled ''Vandy coach says it was time to retire", Vanderbilt Commodores' highly-commended Head Football Coach Bobby Johnson stepped down abruptly from his post yesterday, three weeks before the new season begins. He is replaced by Assistant Head Coach Robbie Caldwell, emblematic for a common trend in U.S. higher education. Everywhere these days, long-standing leaders with expensive pay packages are being replaced with less costly in-house promotions (07/15/10).
  • In his article for The New York Times with the title "In Case of Emergency: What Not to Do" dated Aug. 21, 2010, Peter S. Goodman quotes the communications strategist Eric Dezenhall observing wisely: "A corporation in crisis is not a corporation. It is a collection of panicked individuals motivated by self-preservation.” We only need to substitute 'corporation' with 'institution of higher learning' to understand the situation in which many universities and colleges find them themselves today (08/22/10).
  • According to Getahn Ward's report with the title "Children's Hospital Chief is leaving" posted online in The Tennessean today, the CEO of Vanderbilt University's Monroe Carell Jr. Children's Hospital, Kevin B. Churchwell, is leaving. This is the second senior academic medical officer departing from Vanderbilt University in a bit more than a year. In June of last year, Vice Chancellor of Health Affairs Harry Jacobson stepped down. Like Commodores Coach Johnson, who abruptly took his retirement two months ago, Dr. Churchwell will be replaced by his assistant (09/21/10).
  • Jennifer Brooks' report in The Tennessean with the title "Gifts to Vanderbilt endowment soar as other charities struggle" published online today, Vanderbilt University's endowment lost 300 million dollars or 8.6 percent in the past fiscal year. On the other hand, the university succeeded in raising 84 million dollars in donations, an amount approximately equivalent to the anticipated losses in Medicare payments in the coming year (10/21/10).
  • According to Lauren Etter's post with the title "More Get $1 Million to Lead Colleges" published online in The Wall Street Journal today, the Chancellor of Vanderbilt University Nick Zeppos was the country's second-highest paid university leader in 2008, earning $2.8 million dollars. He was promoted in-house, after E. Gorden Gee left Vanderbilt University for Ohio State University in 2007 (11/14/10).
  • Tamar Lewin reports in her article with the title "Private-College Presidents Getting Higher Salaries" published online Dec. 4, 2011, in The New York Times that according to The Chronicle of Higher Education Vanderbilt University's Chancellor Nick Zeppos garnered $1,843,746.- in 2009. According to a broadcast by Nashville National Public Radio (WPLN) with the title "Zeppos Commits to Cut Pay" on Mar. 12, 2009, the Chancellor had promised to voluntarily accept reduced pay after the sudden, painful loss in endowment investment value of roughly 30 percent in the wake of the financial crisis of 2008 (12/12/2011).
  • More than a decade of expansion have come to an end: Vanderbilt University is in the process of eliminating more than 1,000 jobs in mass lay-offs at its medical center this fiscal year. Vice Chancellor of Health Affairs, Dean of the Medical School and CEO Jeffrey Balser chose not to mince words. According to The Tennessean's post with the title "Vanderbilt University Medical Center eliminates 275 jobs of 1,000 to be cut" published online Sep. 20, 2013, Balser noted: “Some have been concerned that VUMC has been ‘too transparent’ about the need to reduce staffing,...” At the end of the day for-profit TriStar Centennial Health may stand ready to absorb Vanderbilt's operation at a good price, while the current leadership will be rewarded with golden parachutes(02/21/2013).
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Sunday, July 26, 2009

Computers & The Mind

Yesterday, The New York Times published an illuminating article by John Markoff on the promises and fears inherent in the development of artificial intelligence and robotics. Experts in the field discussed the issues at a meeting recently convened near Monterey, California. Computers are our tools. They may store greater amounts of data and process more information faster than a person. However, there is more to intelligence than that. I have written about some fundamental requirements in my post dated Dec. 10, 2007.

In his article, Markoff poses the question whether computers may take over our lives one day. In my mind, they already have in fundamental ways. Think of contemporary warfare! Christopher Drew reports in his article for The New York Times published Mar. 16, 2009, that the U.S. Department of Defense seeks to  expand the use of Predator drones for missions in Afghanistan. The unmanned drones are piloted out of military bases in Nevada and Arizona. After fighting the enemy, the pilot returns to a peaceful family life at home. The war is left halfway around the globe for another day. The enemy's chances of reaching Las Vegas or Phoenix are minuscule. The pilot's life is never in danger. No doubt, this type of progress is greatly desirable. However, the situation produces a profound disconnect between our actions and their consequences.

When I was a student, we had a professional photographer as next-door neighbor. Erich Plöger was quite a character. He was of a much older generation. As as a little boy, he had seen Hitler in the flesh. According to his recollection, Hitler was "a small man wearing a big hat, eyeing people nervously from under a wide brim, while making his way through the crowd in great haste. April must have been close.

Despite the age difference, Erich's profoundly independent lifestyle endeared him to us students. He freelanced out of his apartment. A gigantic Hasselblad bellows camera was towering in his living room. Its large cassette film plates were developed in the bathroom. Prints were also made there on a wooden board placed on the tub in the light of a dim light bulb hand-painted red by Erich himself. Erich and I spent quite a few hours in this room, printing the pictures for my Master's thesis. I had to supply the paper. Everything else, plus expert advice, was on the house.

On one visit, Erich showed me a remarkable book he had co-authored on the peoples of Afghanistan. Erich had won awards with his photography. The pictures were of stunning beauty. I still recall vividly the wild expressions of horse and rider in the pictures he took during a Buzkashi game. Only Erich could have taken such photographs. He had the same wild streak. The book entitled "Buskaschi in Afghanistan" is out of print, but can still be found used and new.

His journey through Afghanistan had taken several months. He traveled in small company. I pelted him with questions. Wasn't it expensive, I wondered. “Not at all,” replied Erich. “Wasn't it dangerous, being pretty much all by yourself?”  “No, not really,” was his answer. “Do you speak the language?” “Very little,” he said, “but the locals were very helpful and hospitable.” They felt honored to have an "effendi" from a far-way land as a guest who wanted to learn about their way of life.

Erich must have undertaken his journey in the 1970s. Since, decades of war have ravaged Afghanistan. Westerners had a heavy hand in the events, changing local attitudes substantially. At present, American drones rule the skies. It is a good assumption that Erich, attempting to repeat his adventure today, would have been kidnapped or worse on the second day. Insights that open our eyes to the peoples of Afghanistan are ever more difficult to come by. Robots play a crucial role in this alienation.  They permit a physical and mental distance that removes us from an immediate understanding of the consequences of our actions.

Albert Schweitzer would have been more alarmed than ever at the computer-facilitated disconnect, numbing our sense of empathy.


  • Elizabeth Bumiller's article entitled "Remembering Afghanistan's Golden Age" in yesterday's New York Times provides a good impression of the country during Erich's visit. I remember that just about every visitor to Afghanistan at that time returned with a sheepskin jacket like the ones shown in the slide show (10/18/09).
  • Today, Terry Gross interviewed Jane Mayer on National Public Radio's Fresh Air. Ms. Mayer published an insightful article on the use of drones in this week's issue of The New Yorker with the title "The Predator War". The interview (hear podcast) lays out the pros and cons of the current clandestine U.S. drone program, operating on the border between Afghanistan and Pakistan (10/21/09).
  • No one more aptly foresaw the future problems in the region than Richard Reeves. The insights in his book "Passage to Peshawar: Pakistan, between the Hindu Kush and the Arabian Sea"published in 1984 are still pertinent today (10/23/09).
  • The events of recent months have demonstrated in great clarity the strengths and the weaknesses of the drone program. The drones have become sufficiently sophisticated to eliminate leaders among the Taliban with unprecedented precision. However, every warlord has a brother, son or cousin ready to step into their shoes when the time comes and carry on their mission without substantial interruption. The Mehsud are a case in point. A drone attack killed the clan's leader Baitullah five months ago. The organization was able to mount a lethal retaliatory counterattack with equal precision last week. The person on the left in the video below is the clan's new leader. His weapon is seated on the right. The drones may instill great fear among the Pashtuns. But will they help bring peace to the peoples of Afghanistan (01/10/10)?
  • According to Greg Miller's report with the title "Increased U.S. drone strikes in Pakistan killing few high-value militants" published online in The Washington Post today, 118 CIA drone strikes eliminated at least 581 Taliban and al-Qaeda militants in Pakistan last year, among whom between one and three dozen were considered 'high value' commanders, depending on definition, and only two were on the list of most-wanted terrorists that the U.S. maintains.
  • The Afghanistan campaign appears to be turning into yet another March of Folly. We seem unable to disengage without a loss of face (08/09/2011).
  • The Pakistani journalist Ahmed Rashid, author of Descent into Chaos: The U.S. and the Disaster in Pakistan, Afghanistan, and Central Asia and Taliban: Militant Islam, Oil and Fundamentalism in Central Asia, Second Edition, wrote an insightful opinion piece with the title "Hate Begat Hate" published online in The New York Times' SundayReview Sep. 10, 2011, on the development of Pakistani relations and perceptions towards the USA over the past decade. The comments are worthwhile reading as well (09/11/2011).
  • An insightful insider's perspective on the changes in Afghan life over the past fifty years (12/06/2012).
  • If you cannot find Erich Plöger's book, on May 4, 2014, National Public Radio published an impressive multi-media documentary under the headline "Buzkashi" about Afghanistan's most favorite past time (05/07/2014).

Tuesday, July 21, 2009

The Very Plastic Axolotl

Axolotls (Ambystoma mexicanum) are a species of tiger salamander that used to populate the lake on which Mexico City grew. Grown ups commonly measure 23 cm (9 inches) in length. Axolotls are distinct from other amphibians in that they usually do not undergo metamorphosis. Although the salamanders develop lungs, most reach adulthood without shedding their external gills and retain an aquatic lifestyle, using both sets of organs to breathe. The preservation of juvenile traits is known as neoteny.

In my post dated Jun. 23, 2008, I have written about a hormone produced in the brain that seasonally alters hamster behavior and physiology. More dramatically, another brain hormone profoundly alters the axolotls' gross anatomy. That is, the administration of thyroid stimulating hormone (TSH), a hormone excreted by the pituitary gland, overcomes neoteny, inducing metamorphosis into a terrestrial salamander without gills. TSH stimulates the production of thyroxine in the thyroid. Iodine is a component of thyroxine. Therefore, adding thyroxine or iodine to the water also triggers metamorphosis. Dwindling water levels are thought to increase TSH production, inducing the transformation naturally. As consequence, two distinct, mature life forms of the same species may coexist.

In addition to the capacity to profoundly adapt to a change in the environment, axolotls exhibit an astounding ability of limb restoration after injury. The tissue surrounding the wound does not scar. Instead, the salamanders can regenerate a fully functional new limb within weeks after the loss. Recent research shows that the skin cells do not revert into pluripotent undifferentiated stem cells (Kragl and others, 2009). Rather, remnant cells from each tissue of the limb collectively form clusters, known as blastema. The blastema cells are more restricted in their potential than stem cells, constituting progenitors predestined to redevelop the components of the limb. The whole process seems to unfold like an intricate, precise molecular machinery that completes its mission according to plan without fail, once the cog is pulled. A timed, sweeping cascade of molecular signaling pathways switches the expression of genes, the product of which control the expression of other genes, resulting in orderly, topographic cell division and differentiation. Unraveling the molecular signals that set these processes in motion may lead to great advances in regenerative medicine.    

In accord with the axolotls' striking capacity to fully regenerate limbs, the animals show a high degree of brain plasticity. I saw the otherworldly creatures close up for the first time, when I visited a friend working on his thesis in another laboratory at my alma mater. His professor had accomplished to produce fully functional axolotls with an additional vestibular system, successfully grafting in embryos heads with the premordia for the vestibular system onto bodies with another set of vestibular premordia (Brändle, 1977). The vestibular system endows the animals with a sense of balance and motion. In some animals, sensory nerve cells in the added vestibular system had grown connections intermeshed with those of the other vestibular system, providing sensory input to the processing stations of the vestibular pathway in the brain. The professor examined how the additional input affected the salamanders' reaction to rotation. He observed that the operated salamanders responded significantly more vigorously to rotation than unoperated salamanders. Apparently, the added vestibular nerve fibers he observed in histological preparations found appropriate targets in the brain and the information they conveyed was successfully integrated in the sensory pathway, translating into action proportionate to the enhanced input. Hence, axolotls constitute impressive examples for the formidable potential of vertebrates not only to repair themselves, but also to reorganize the nerve cell networks in their central nervous system according to a modified sensory periphery.

The video shows axolotls that had the genes for green fluorescent protein (GFP) inserted into their genome. Kragl and others, (2009) used similar labeling techniques to distinguish among blastema cells. I wrote about Douglas Prasher who cloned and sequenced GFP, making this video possible, in my post dated Oct. 23, 2008. Enjoy the show:

  • The Italian scientist Lazzaro Spallanzani was the first to report the salamander's ability of regenerating a limb, succeeding in regrowing tails (Spallanzani, 1768; for review in English see Tsonis and Fox, 2009). He also was the first to suggest that small bats must posses an extraordinary sense of orientation different from vision, known as echolocation today. I wrote about the controversy this idea stirred in his day in post with the entitle "Echolocation, Science & Power" published Sep. 3, 2009 (10/14/10).
  • Brändle K (1977) Quantitive studies of the reactions to horizontal angular accelerations in axolotls. II. head-turning reflexes in animals with a supernumerary pair of labyrinths. J Exp Biol 66:15-31.
  • Spallanzani L (1768) Prodromo di un opera da imprimersi sopra la riproduzioni anamali. Giovanni Montanari, Modena. Translated in English by Maty M. 1769. An essay on animal reproduction. London: T. Becket & DeHondt.
  • Kragl M, Knapp D, Nacu E, Khattak S, Maden M, Epperlein HH, Tanaka EM (2009) Cells keep a memory of their tissue origin during axolotl limb regeneration. Nature 460:60-65.
  • Tsonis PA, Fox TP (2009) Regeneration according to Spallanzani. Dev Dyn 238:2357-2363.
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Saturday, July 18, 2009

No Country for Shrinking Violets

I have written about the effects of the catastrophic meltdown of the U.S. financial market on American academic institutions in my post dated Dec. 9, 2008. Since, the addenda have surpassed the original post. Private and public colleges and universities have become deeply affected by the credit crunch and loss in revenue. This is a time for truthful, unambiguous and clear messages.

The other day, I leaved through the official newspaper of a major private research university I was visiting. I found only great news on the front page. We are doing well! Two pages into the paper, psychologists advised the readership on stress management in hard economic times. The next pages were filled with accounts from employees on how they cope with their current financial constraints and evaporating retirement plans.

I was reminded of Spring 1986. In the aftermath of the nuclear reactor meltdown at Chernobyl near Kiev in the Ukraine, clouds of radioactive material dusted Germany and her neighbors. Dosimeters rang alarms. Public health agencies were expected to advise the population on the impending risk and measures of prevention.

The incident led to an avalanche of conflicting messages across countries. The severity of the outlook depended on each nation's standards. The ideas about acceptable radiation absorbed doses varied. Hence, milk was pronounced safe in Switzerland, whereas across the Rhine in Germany the judgments varied from discouragement to restraint consumption, depending of the color of state government. In states where the environmentally conscientious Greens party shared gubernatorial powers, regular fresh milk was taken from the shelves. Other states left the decision to the consumer. Zero becquerel milk sold in no time for six times the price of untested milk.

Adding to the confusion, mixed messages were issued in the same jurisdictions. Some state health agencies of the Federal Republic advised citizens that they had nothing to worry about. But, just as a precaution, parents might consider not to let their children play in their sandboxes outside. The public was left profoundly alarmed and bewildered. It took a prolonged and concerted effort on state and federal levels to eventually calm the situation down.

In retrospect, the reactor accident in Chernobyl appears to have had no detectable averse effects on public health in Germany. However, the next time opposition parties formed a national government, the Greens became junior coalition partner, garnering one of the most prestigious ministerial offices. That is, Joschka Fischer, who held the office of Minister of Environmental Protection in the state of Hesse at the time of the Chernobyl accident, was appointed Vice Chancellor of the federal government and Minister of Foreign Affairs, the portfolio corresponding to the Secretary of State of the United States. Joschka Fischer, who had gained fame and notoriety as a radical leader of the 1960s student revolt, performed exceptionally well in his important new job, despite all reservations. This constituted a great success for the small party which was hitherto seen as inept to govern with national responsibility.

The lesson to be learned for the present day is that in times of crisis leaders of enterprises large and small, private and public, can ill-afford mixed messages. If conclusive answers cannot be given, we expect to be told the reasons. Moreover, we anticipate from outstanding leaders that they do not hesitate to deliver bad news in a timely fashion. America's colleges and universities educate tomorrow's leadership. Their senior academic executive officers must serve as accomplished role models of leadership at a time of great challenges.


  • In contrast to Germany and her neighbors, the impact of the radioactive fallout in the wake of the reactor accident was catastrophic for the former Soviet Union. Some estimates put the death toll as high as 50,000 citizens. Alison Smale published an informative article entitled "Revealing Secret Spots That Evoke Dark Secrets" about the grave consequences of this experiment gone wrong in today's issue of The New York Times (08/25/09).
  • Chloe White reported in her post entitled "Carson-Newman revealing facing funding issues" on dated Sep. 19, 2009, about the cost-cutting measures with which Carson-Newman College in Jefferson City, Tennessee, plans to fight its budget shortfall. President J. Randall O'Brien told faculty and staff last August "any institution that believes it can remain the same in this economy is delusional." Mark his words (09/21/09).
  • After more than a decade of boom comes the bust: Vanderbilt University is in the process of eliminating more than 1,000 jobs in mass lay-offs at its medical center this fiscal year. This time Vice Chancellor of Health Affairs, Dean of the Medical School and CEO Jeffrey Balser chose not to mince words. According to The Tennessean's post with the title "Vanderbilt University Medical Center eliminates 275 jobs of 1,000 to be cut" published online Sep. 20, 2013, Balser noted: “Some have been concerned that VUMC has been ‘too transparent’ about the need to reduce staffing,...” Now it seems there will be no holding back (02/20/2013)!
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