Baker Center Journal of Applied Public Policy - Vol. IV, No. I

This is the 4th volume of the Baker Center Journal on Applied Public Policy. It includes articles on nuclear nonproliferation, American political development, election issues, Tennessee state trial courts, attitudes related to rich and poor people, and two student articles on science, innovation, technology and economic growth and explosive trace detection at airports

SARS Surveillance during Emergency Public Health Response, United States, March–July 2003

In response to the emergence of severe acute respiratory syndrome (SARS), the United States established national surveillance using a sensitive case definition incorporating clinical, epidemiologic, and laboratory criteria. Of 1,460 unexplained respiratory illnesses reported by state and local health departments to the Centers for Disease Control and Prevention from March 17 to July 30, 2003, a total of 398 (27%) met clinical and epidemiologic SARS case criteria. Of these, 72 (18%) were probable cases with radiographic evidence of pneumonia. Eight (2%) were laboratory-confirmed SARS-coronavirus (SARS-CoV) infections, 206 (52%) were SARS-CoV negative, and 184 (46%) had undetermined SARS-CoV status because of missing convalescent-phase serum specimens. Thirty-one percent (124/398) of case-patients were hospitalized; none died. Travel was the most common epidemiologic link (329/398, 83%), and mainland China was the affected area most commonly visited. One case of possible household transmission was reported, and no laboratory-confirmed infections occurred among healthcare workers. Successes and limitations of this emergency surveillance can guide preparations for future outbreaks of SARS or respiratory diseases of unknown etiology

The NANOGrav Nine-year Data Set:Mass and Geometric Measurements of Binary Millisecond Pulsars

We analyze 24 binary radio pulsars in the North American Nanohertz Observatory for Gravitational Waves (NANOGrav) nine-year data set. We make 14 significant measurements of the Shapiro delay, including new detections in four pulsar-binary systems (PSRs J0613−0200, J2017+0603, J2302+4442, and J2317+1439), and derive estimates of the binary-component masses and orbital inclination for these MSP-binary systems. We find a wide range of binary pulsar masses, with values as low as ${m}_{{\rm{p}}}={1.18}_{-0.09}^{+0.10}\,{M}_{\odot }$ for PSR J1918−0642 and as high as ${m}_{{\rm{p}}}={1.928}_{-0.017}^{+0.017}\,{M}_{\odot }$ for PSR J1614−2230 (both 68.3% credibility). We make an improved measurement of the Shapiro timing delay in the PSR J1918−0642 and J2043+1711 systems, measuring the pulsar mass in the latter system to be ${m}_{{\rm{p}}}={1.41}_{-0.18}^{+0.21}\,{M}_{\odot }$ (68.3% credibility) for the first time. We measure secular variations of one or more orbital elements in many systems, and use these measurements to further constrain our estimates of the pulsar and companion masses whenever possible. In particular, we used the observed Shapiro delay and periastron advance due to relativistic gravity in the PSR J1903+0327 system to derive a pulsar mass of ${m}_{{\rm{p}}}={1.65}_{-0.02}^{+0.02}\,{M}_{\odot }$ (68.3% credibility). We discuss the implications that our mass measurements have on the overall neutron-star mass distribution, and on the "mass/orbital-period" correlation due to extended mass transfer

The Presidency and the Executive Branch in Latin America: What We Know and What We Need to Know

The presidential politics literature depicts presidents either as all- powerful actors or figureheads and seeks to explain outcomes accordingly. Th e president and the executive branch are nonetheless usually treated as black boxes, particularly i n developing countries, even though the presidency has evolved into an extremely complex branch of government. While these developments have been studied in the U nited States, far less i s known in other countries, particularly in Latin America, where presi dential systems have been considered the source of all goods and evils. To help close the knowledge gap and explore differences in policymaking characteristics not only between Latin America and the US but also across Latin American countries, this paper s ummarizes the vast literature on the organization and resources of the Executive Branch in the Americas and sets a research agenda for the study of Latin American presidencies.Fil: Bonvecchi, Alejandro. Universidad Torcuato Di Tella. Departamento de Ciencia Política y Estudios Internacionales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Scartascini, Juan Carlos. Banco Interamericano de Desarrollo; Estados Unido

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways.

Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4,261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombined<5 × 10(-8)) and used pathway analysis to identify JAK-STAT/IL12/IL27 signalling and cytokine-cytokine pathways, for which relevant therapies exist

Community Violence and Youth: Affect, Behavior, Substance Use, and Academics

Community violence is recognized as a major public health problem (WHO, World Report on Violence and Health,2002) that Americans increasingly understand has adverse implications beyond inner-cities. However, the majority of research on chronic community violence exposure focuses on ethnic minority, impoverished, and/or crime-ridden communities while treatment and prevention focuses on the perpetrators of the violence, not on the youth who are its direct or indirect victims. School-based treatment and preventive interventions are needed for children at elevated risk for exposure to community violence. In preparation, a longitudinal, community epidemiological study, The Multiple Opportunities to Reach Excellence (MORE) Project, is being fielded to address some of the methodological weaknesses presented in previous studies. This study was designed to better understand the impact of children’s chronic exposure to community violence on their emotional, behavioral, substance use, and academic functioning with an overarching goal to identify malleable risk and protective factors which can be targeted in preventive and intervention programs. This paper describes the MORE Project, its conceptual underpinnings, goals, and methodology, as well as implications for treatment and preventive interventions and future research

environmental governance reconsidered

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