Capacity and Autonomy : An Exploration of Fukuyama’s Governance Hypothesis

Peer reviewe

Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes.

Abstract BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo. (Funded by Amylin Pharmaceuticals; EXSCEL ClinicalTrials.gov number, NCT01144338 .)

Monitoring and Disrupting Dark Networks A Bias toward the Center and What It Costs Us

The goal of this article is to explore this analytic bias--how it is manifested, why it appears so extensive, and what unwitting limitations it imposes on our strategic options to counter terrorism. We use data from a study of the Syrian opposition network that was conducted in the CORE Lab at the Naval Postgraduate School in Monterey California (Lucente and Wilson 2013). The original study sought to provide a window into the armed opposition units against the regime of Syrian President Bashar Assad. This article proceeds as follows: We begin by reviewing the various strategies that can be used for disrupting dark networks. These can be broken down into two broad categories -- kinetic and non-kinetic. The former uses coercive means for disruption while the latter seeks to undermine dark networks using with subtler applications of power. Drawing on a previous analysis, we illustrate how some of these strategies can be implemented, while at the same time highlighting our own bias in that study toward central actors. We then turn to an analysis of the Syrian opposition network, highlighting how a central focus can blind analysts to other important aspects of a network; in this case, elements that ultimately aligned themselves with the Islamic State of Syria (ISIS). We conclude with some implications for the future use of SNA to monitor and disrupt dark networks