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While international demand for sales positions is growing, negative sales stereotypes, partially fueled by ethical abuses in the sales arena, are prevalent and may dissuade students from pursuing sales careers. To help combat the situation globally, educators must develop and utilize effective sales ethics pedagogies. The first step involves understanding cross-cultural sales ethics perspectives. A convenience sample is drawn from five countries (United States, France, Germany, Indonesia, and New Zealand), and the Personal Selling Ethics Scale (PSE-2) is successfully used to examine culturally specific and gender-based evaluation differences. Gender-based ethical perspectives are of particular interest due to the growing gender diversity within sales professions. The study finds that cultural traditionalism/secularism and individualism/collectivism affect sales ethics evaluations. Likewise, gender and moral ideology affect evaluations. Women are more sensitive to ethical misconduct than men, and absolutist are more sensitive than exceptionists, situationists, and subjectivists. Specific pedagogical recommendations are provided.

Although the education community has identified numerous effective interventions for improving the literacy of U.S. schoolchildren, little headway has been made in raising literacy capabilities. David K. Cohen and Monica P. Bhatt, of the University of Michigan, contend that a major obstacle is the organizational structure of the U.S. education system. Three features in particular--the lack of educational infrastructure, a decentralized governance system, and the organization of teaching as an occupation--stymie efforts to improve literacy instruction. The authors emphasize that the education system in the United States has always been a patchwork of local school systems that share no common curricula, student examinations, teacher education, or means of observing and improving instruction. Although localities have broad powers over education, few have built the capability to judge or support quality in educational programs. The quality criteria that have developed chiefly concern teachers, not teaching. The decentralization and weak governance of U.S. schooling also deprives teachers of opportunities to build the occupational knowledge and skill that can inform standards for the quality of work, in this case instruction. And, unlike practitioners in other professions teachers have little opportunity to try to strengthen teaching quality by setting standards for entry to the occupation. Cohen and Bhatt review six types of organizational reforms undertaken over the past several decades to improve literacy and other academic outcomes for U.S. students. After briefly describing accountability, comprehensive school reforms, knowledge diffusion, improvement of human capital, and market-based reforms, the authors turn to the Common Core State Standards, an effort initiated by state governors and school leaders to raise student achievement. The authors conclude that the fundamental question about the Common Core, as with the other reforms they discuss, is whether educators and policy makers can mobilize the capability to help states and localities invent, adapt, and implement reliable ways to improve instruction. (Contains 41 endnotes.)

When inspectors visit construction sites to assess the quality of work, they do so against the building code, which typically is written out in detail and used to guide work and teach apprentices. When attending physicians supervise interns as they take patients' histories or check their blood pressure, they compare the interns' work with established procedures, many of which are written down and used to guide work and teach novices. In these cases and many others, the assessment of quality in workers' performance is framed by and conducted in light of occupational standards. That is not the case for teaching in U.S. K-12 schools. There are no common standards against which teachers' performance could be judged and no inspections of their performance in light of such standards. Because there is no common infrastructure for U.S. public education, it has developed several anomalous features. One of the most important concerns testing: because there is no common curriculum, it is impossible to devise tests that assess the extent of students' mastery of that curriculum. Teacher education is a second anomaly: absent a common curriculum, teachers-in-training could not learn how to teach it, let alone how to teach it well. Lacking an educational infrastructure to rely on, teacher assessment has also been generic, as have standards for the colleges and departments of education that educate teachers. The infrastructure to which the author refers is not radical or unfamiliar for education throughout the world; it is only radical in the United States. The author points out that without a defined K-12 curriculum for teachers to master, education schools tend to offer generic advice, not grounded content and pedagogical knowledge. (Contains 3 endnotes.)

Abortion is now illegal in roughly a third of the country, but abortion pills are more widely available than ever before. Clinics, websites, and informal networks facilitate the distribution of abortion pills, legally and illegally, across the United States, while antiabortion advocates and legislators are adopting all manner of strategies to attack pills. This Article is the first in the legal literature to explore this defining aspect of this new environment and the novel issues it raises at the level of state law, federal policy, and on-the-ground advocacy. The Article begins by detailing anti-abortion strategies to stop pills by any means necessary. These tactics include a federal lawsuit attacking the approval and regulation of mifepristone, one of two abortion pills; a revival of the long-unenforced Comstock Act's ban on mailing anything that induces an abortion; a redefinition of abortion's location to chill the provision of medication abortion; attacks on online information and pill supply chains; and attempts to target both those who take abortion pills and those who help others access them. We then consider the opposing movement to increase access to abortion pills: abortion shield laws that protect cross-border telehealth, efforts to evade abortion bans through missed period pills and advance provision, and pharmacist prescribing of abortion pills. Finally, we examine how the U.S. Food and Drug Administration (FDA) can use its powers to increase or decrease access to pills, including lifting the unnecessary restrictions on medication abortion, changing the pills' labels, or asserting that FDA rules governing medication abortion partially preempt state abortion bans. The Article concludes by offering the first analysis of how, after Roe's reversal, abortion pills and their attendant controversies are transforming the abortion debate in this country. With pills, state governments and the medical establishment will lose even more control over abortion; rather, informal and underground networks will meet much of the demand for abortion pills, cutting out gatekeepers. The wide availability of pills will also reshape the definition of abortion--which is ill-suited for the ambiguities of drug provision--and could destigmatize abortion care. At the same time, however, attempts to punish people who provide or use pills will exacerbate the public health and criminal justice consequences that new abortion bans have wrought, entrenching existing class and race disparities. Thus, as abortion pills proliferate--both within and outside of law--abortion inequities could as well. Ultimately, these emerging legal issues will profoundly alter how people think about abortion. [ABSTRACT FROM AUTHOR]

Mitral valve transcatheter edge-to-edge repair (MTEER) was approved in the United States for treatment of functional mitral regurgitation (FMR) based on results from the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial. The authors sought to analyze outcomes of MTEER in FMR patients who would have been excluded from COAPT. MTEER procedures performed for FMR in the TVT (Transcatheter Valve Therapy) Registry between January 1, 2013, and April 30, 2020, were categorized as "trial-ineligible" if any of the following were present: cardiogenic shock, inotropic support, left ventricular ejection fraction <20%, left ventricular end-systolic dimension >7 cm, home oxygen use, or severe tricuspid regurgitation. Trial-ineligible and trial-eligible groups were compared through 1 year using multivariable models. The primary endpoint was 1-year death or heart failure hospitalization (HFH). Of 6,675 patients who underwent MTEER for FMR, 3,721 (55.7%) were trial-eligible and 2,954 (44.3%) were trial-ineligible. Trial-ineligible patients had lower rates of technical procedural success (86.9% vs 92.6%; P < 0.001) and more frequent in-hospital complications (11.8% vs 5.7%; P < 0.001) compared with trial-eligible patients. A clinically meaningful improvement in health status at 30 days was observed in 78.9% and 77.0% of patients in the trial-ineligible and trial-eligible groups, respectively. There was a higher risk of 1-year death or HFH (HR: 1.73; 95% CI: 1.57-1.91; P < 0.001) in trial-ineligible patients. Among patients who underwent MTEER for FMR in the TVT Registry, nearly one-half would have been ineligible for the COAPT trial. Health status improvement at 30 days was similar in COAPT-ineligible and COAPT-eligible patients, but trial-ineligible patients had higher 1-year rates of death or HFH. [Display omitted] [ABSTRACT FROM AUTHOR]

In anticipation of extraterritorial application of antiabortion laws, many states have enacted laws that attempt to shield abortion providers, helpers, and patients from civil, professional, or criminal liability associated with legal abortion care. This essay analyzes and compares the statutory schemes of the seven early adopting shield states: California, Connecticut, Delaware, Illinois, Massachusetts, New Jersey, and New York. After describing what the laws do and how they operate, we offer reflections on coming disputes, areas of legal uncertainty, and ways to improve future shield laws. [ABSTRACT FROM AUTHOR]

Aims: Obstructive hypertrophic cardiomyopathy (oHCM) is a disease of the cardiomyocyte in which dynamic left ventricular outflow track obstruction may lead to heart failure, valvular disease, and sudden death. Little is known about healthcare resource utilization (HRU) and costs associated with oHCM. This study investigated the clinical and economic burden of oHCM in patients with or without symptoms associated with oHCM. Methods: We used the US IBM MarketScan Commercial and Medicare Supplemental database to identify patients with oHCM (January 2009-March 2019). Control patients without cardiomyopathy were matched to each patient with oHCM based on age, sex, region, and index year (3:1 ratio). One-year HRU and cost data were compared between all oHCM, symptomatic oHCM, and asymptomatic oHCM subgroups, and their respective controls. Results: Among 11,401 eligible patients with oHCM (mean age 57 years, 42% female), 5,667 (50%) were symptomatic (23% chest pain, 57% dyspnea, 29% fatigue, 17% syncope). oHCM was associated with significant increases in all-cause hospitalizations, hospital days, outpatient visits, and total healthcare costs (mean ± standard deviation: $26,929 ± 77,720 vs. $6,808 ± 25,712, p<.001) compared with matched controls. These differences were driven mainly by the clinical and economic burden of symptomatic oHCM, which was associated with significant increases in 1-year hospitalization rates (38.0 vs. 6.9%), hospital days (3.7 ± 9.9 vs. 0.4 ± 3.0), and total healthcare costs ($43,586 ± 103,756 vs. $6,768 ± 27,618; all p<.001). Adjustment for comorbidities had minimal impact on these differences. Limitations: The use of claims data relies on International Classification of Diseases (ICD-9 and ICD-10) diagnosis codes, which might be inaccurate. Only commercially insured patients were included. Conclusion: In a real-world population, oHCM was associated with substantial increases in HRU and incremental costs of ≥$20,000/year when compared with matched controls--a difference that increased to ≥$35,000/year among symptomatic patients. Further studies are warranted to understand the potential impact of specific therapies on HRU and the economic burden of oHCM. PLAIN LANGUAGE SUMMARY Obstructive hypertrophic cardiomyopathy (oHCM) is a medical condition in which the heart muscle becomes abnormally thick and can cause partial blockage of blood flow out of the heart. Some patients experience symptoms (such as shortness of breath, chest pain, and fatigue) from this condition while others do not. Little is known about the healthcare resource utilization (HRU) and costs associated with oHCM, and if there are any differences between patients with oHCM who experience symptoms versus those who are asymptomatic. Therefore, we performed a study to investigate the clinical and economic burden of oHCM in patients with or without symptoms associated with oHCM. Based on insurance claims data, ≥50% of all patients with diagnosed oHCM are symptomatic. Symptomatic patients experience nearly 8 times as many hospitalizations and cost the healthcare system >$35,000 per year more than matched controls. In contrast, asymptomatic patients with oHCM have a much smaller difference in HRU and costs (≥$3,600/year) compared with matched controls. The results of this study suggest that effective therapies for oHCM may provide economic value, even if the impact of therapy is limited solely to the relief of symptoms. [ABSTRACT FROM AUTHOR]

Introduction: The Kidney Allocation System in the United States prioritizes candidates with Estimated Post-Transplant Survival (EPTS) ≤20% to receive deceased donor kidneys with Kidney Donor Profile Index (KDPI) ≤20%. Research Question: We compared access to KDPI ≤ 20% kidneys for EPTS ≤ 20% candidates across the United States to determine whether geographic disparities in access to these low KDPI kidneys exist. Design: We identified all incident adult deceased donor kidney candidates wait-listed January 1, 2015, to March 31, 2018, using United Network for Organ Sharing data. We calculated the proportion of candidates transplanted, final EPTS, and KDPI of transplanted kidneys for candidates listed with EPTS ≤ 20% versus >20%. We compared the odds of receiving a KDPI ≤ 20% deceased donor kidney for EPTS ≤ 20% candidates across regions using logistic regression. Results: Among 121 069 deceased donor kidney candidates, 28.5% had listing EPTS ≤ 20%. Of these, 16.1% received deceased donor kidney transplants (candidates listed EPTS > 20%: 17.1% transplanted) and 12.3% lost EPTS ≤ 20% status. Only 49.4% of transplanted EPTS ≤ 20% candidates received a KDPI ≤ 20% kidney, and 48.3% of KDPI ≤ 20% kidneys went to recipients with EPTS > 20% at the time of transplantation. Odds of receiving a KDPI ≤ 20% kidney were highest in region 6 and lowest in region 9 (odds ratio 0.19 [0.13 to 0.28]). The ratio of KDPI ≤ 20% donors per EPTS ≤ 20% candidate and likelihood of KDPI ≤ 20% transplantation were strongly correlated (r 2 = 0.84). Discussion: Marked geographic variation in the likelihood of receiving a KDPI ≤ 20% deceased donor kidney among transplanted EPTS ≤ 20% candidates exists and is related to differences in organ availability within allocation borders. Policy changes to improve organ sharing are needed to improve equity in access to low KDPI kidneys. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate changes in volume, risk profile, and outcomes among elderly individuals undergoing isolated aortic valve replacement (AVR) after TAVR approval in the United States. Retrospective cohort study of patients ≥65 years old with at least one procedural code for isolated SAVR or TAVR among the Medicare beneficiaries between January 1, 2009 and December 31, 2014. A total of 137,563 hospitalizations for isolated AVR between 2009 and 2014 were included (SAVR: 102,968 [74.9%]; TAVR: 34,595 [25.1%]). Overall AVR volumes increased by 21.8% per year after TAVR introduction, compared with 2.3% prior (p ≪ 0.001). Changes in SAVR volumes were similar both before and after TAVR introduction, (2.3% per year growth before vs. 2.1% after, p = 0.24). Although patient risk profiles increased among the AVR population (predicted 30-day mortality 4.0% in 2009 vs. 5.4% in 2014; p for trend =0.048), observed 30-day mortality (4.0% in 2009 vs. 3.9% in 2014; p for trend =0.96) and 1-year mortality (10.8% in 2009 to 12.2% in 2014; p for trend =0.069) rates remained stable. Among elderly U.S. patients enrolled in the Medicare, the introduction and the dissemination in the early phase of TAVR was associated with an expansion of AVR to high risk patients, without an observed reduction in the use of SAVR. This expansion was associated with similar mortality among all AVR patients, despite an increase in patient risk. • SAVR and TAVR volumes both increased in the early phase of expansion of TAVR. • TAVR use led primarily to the expansion of AVR to an elderly and higher risk population. • This expansion was associated with similar mortality among all AVR patients. [ABSTRACT FROM AUTHOR]

Little is known about the population genetics of water balance. A recent meta-genome-wide association study on plasma sodium concentration identified novel loci of high biological plausibility, yet heritability of the phenotype has never been convincingly shown in European ancestry. The present study linked the Vietnam Era Twin Registry with the Department of Veterans Affairs VistA patient care clinical database. Participants (n = 2,370, 59.6% monozygotic twins and 40.4% dizygotic twins) had a median of seven (interquartile range: 3-14) plasma sodium determinations between October 1999 and March 2017. Heritability of the mean plasma sodium concentration among all twins was 0.41 (95% confidence interval: 0.35-0.46) and 0.49 (95% confidence interval: 0.43-0.54) after exclusion of 514 twins with only a single plasma sodium determination. Heritability among Caucasian (n = 1,958) and African-American (n = 268) twins was 0.41 (95% confidence interval: 0.34-0.47) and 0.36 (95% confidence interval: 0.17-0.52), respectively. Exclusion of data from twins who had been prescribed medications known to impact systemic water balance had no effect. The ability of the present study to newly detect substantial heritability across multiple racial groups was potentially a function of the cohort size and relatedness, exclusion of sodium determinations confounded by elevated plasma glucose and/or reduced glomerular filtration rate, transformation of plasma sodium for the independent osmotic effect of plasma glucose, and use of multiple laboratory determinations per individual over a period of years. Individual-level plasma sodium concentration exhibited longitudinal stability (i.e., individuality); the degree to which individual-level means differed from the population mean was substantial, irrespective of the number of determinations. In aggregate, these data establish the heritability of plasma sodium concentration in European ancestry and corroborate its individuality. [ABSTRACT FROM AUTHOR]

The environment of U.S. schools has changed dramatically over a quarter century as standards tied to test-based accountability and market competition became commonplace. We examine the issues that school systems face in this changing environment, to identify considerations for researchers interested in reform as educational system building. We highlight a central dilemma: Systems manage environmental pressures to become more coherent enterprises that focus on tested outcomes while managing the inherited differentiated organizations and environmental pressures which support these enterprises. We identify four activity domains that are defined by these competing pressure: consensus on outcomes; infrastructure to connect outcomes with instruction; recruitment that is aligned with outcomes; and competing environmental pressures. [ABSTRACT FROM AUTHOR]

Background: Dyspnea is a common angina equivalent that adversely affects quality of life, but its prevalence in patients with chronic total occlusions (CTOs) and predictors of its improvement after CTO percutaneous coronary intervention (PCI) are unknown. We examined the prevalence of dyspnea and predictors of its improvement among patients selected for CTO PCI.Methods and Results: In the OPEN CTO registry (Outcomes, Patient health status, and Efficiency iN Chronic Total Occlusion) of 12 US experienced centers, 987 patients undergoing CTO PCI (procedure success 82%) were assessed for dyspnea with the Rose Dyspnea Scale at baseline and 1 month after CTO PCI. Rose Dyspnea Scale scores range from 0 to 4 with higher scores indicating more dyspnea with common activities. A total of 800 (81%) reported some dyspnea at baseline with a mean (±SD) Rose Dyspnea Scale of 2.8±1.2. Dyspnea improvement was defined as a ≥1 point decrease in Rose Dyspnea Scale from baseline to 1 month. Predictors of dyspnea improvement were examined with a modified Poisson regression model. Patients with dyspnea were more likely to be female, obese, smokers, and to have more comorbidities and angina. Among patients with baseline dyspnea, 70% reported less dyspnea at 1 month after CTO PCI. Successful CTO PCI was associated with more frequent dyspnea improvement than failure, even after adjustment for other clinical variables. Anemia, depression, and lung disease were associated with less dyspnea improvement after PCI.Conclusions: Dyspnea is a common symptom among patients undergoing CTO PCI and improves significantly with successful PCI. Patients with other potentially noncardiac causes of dyspnea reported less dyspnea improvement after CTO PCI. [ABSTRACT FROM AUTHOR]

This article reports on the increase of Middle Eastern students in universities in Australia and New Zealand because of difficulties in getting visas for the United States and Britain. Difficulties in securing visas, combined with more aggressive recruiting by higher-education institutions in New Zealand and Australia, have led a growing number of Middle Eastern students to study in the South Pacific. The change has been swift. In 2002, New Zealand's eight universities enrolled fewer than 50 Middle Eastern students. Today some 1,800 students from Saudi Arabia alone are enrolled at those institutions. Most are there to study English, but about one in five is enrolled in a full-time degree program. Over the past four years, Australia's 40 universities have seen their Middle Eastern enrollments almost triple, to 7,000, making Australia the third-largest destination for students from the region, according to government figures. The most obvious catalyst for this growth has been the unprecedented level of scrutiny that international students coming to Britain and United States now face.

Background: Drug-eluting stents (DES) reduce restenosis but require prolonged antiplatelet therapy, when compared with bare metal stents. Ideally, the patient should be involved in this risk:benefit assessment prior to selecting DES, to maximize the benefits and cost-effectiveness of care, and to improve medication adherence. However, accurate estimation of restenosis risk may require angiographic factors identified at cardiac catheterization.Methods: In a large PCI registry, we used logistic regression to identify clinical and angiographic predictors of clinically-driven target lesion revascularization (TLR) over the first year after stent placement. Discrimination c-statistic and integrated discrimination improvement (IDI) were used to calculate the incremental utility of angiographic variables when added to clinical predictors.Results: Of 8501 PCI patients, TLR occurred in 4.5%. After adjusting for DES use, clinical TLR predictors were younger age, female sex, diabetes, prior PCI, and prior bypass surgery (model c-statistic 0.630). Angiographic predictors were vein graft PCI, in-stent restenosis lesion, longer stent length, and smaller stent diameter (c-statistic 0.650). After adding angiographic factors to the clinical model, c-statistic improved to 0.680 and the average separation in TLR risk among patients with and without TLR improved by 1% (IDI=0.010, 95% CI 0.009-0.014), primarily driven by those experiencing TLR (from 5.9% to 6.9% absolute risk).Conclusions: Among unselected PCI patients, the incidence of clinically-indicated TLR is <5% at 1-year, and standard clinical variables only moderately discriminate who will and will not experience TLR. Angiographic variables significantly improve TLR risk assessment, suggesting that stent selection may be best performed after coronary anatomy has been delineated.Short Summary (for Annotated Table Of Contents): Although several recent studies have challenged traditional expectations regarding the duration of dual antiplatelet therapy, current guidelines recommend at least 6 to 12months of treatment after implantation of a drug eluting stent, with a shorter course for bare metal stents. Stent selection ideally should involve input from the patient receiving these stents, but multiple studies have suggested that angiographic factors - obtained after the patient has received sedation during the diagnostic catheterization - are important predictors of repeat revascularization. In this analysis from a large registry of patients receiving coronary stents, angiographic characteristics were found to significantly improve risk assessment for target lesion revascularization, when added to clinical variables alone. [ABSTRACT FROM AUTHOR]

Objectives Longitudinal data are limited regarding outcomes and costs beyond 1 year after acute myocardial infarction ( MI) among elderly (≥65 years old) US patients. This study examined long-term outcomes and healthcare costs among elderly MI survivors. Methods Retrospective analysis of 2002-2009 Medicare healthcare claims (5% random sample). Patients were ≥65 years old and survived ≥1 year without recurrent MI after MI hospitalization. Mortality, incidence of hospitalizations for stroke, major bleeding, MI, a composite endpoint (death, MI, or stroke), and nonpharmacy healthcare costs were determined. Results Eligible patients included 16 244 STEMI, 34 576 NSTEMI, and 3109 unspecified MI. NSTEMI and unspecified MI patients had significantly higher prevalence of comorbidities than STEMI patients, except for hypertension and dyslipidemia. MI incidence declined 36% over the follow-up (3.82/100 person-years [ PY] to 2.45/100 PY). Mortality, stroke, and bleeding decreased until the third year of follow-up and then increased. NSTEMI and unspecified MI patients had a significantly higher incidence of death, MI, the composite, and bleeding than STEMI patients throughout follow-up. All-cause inpatient costs during follow-up were 2.6- and 1.9-fold higher than baseline for STEMI and NSTEMI, respectively; cardiovascular-related inpatient costs were 3.5- and 2.2-fold higher, respectively. Conclusions Risks of mortality and cardiovascular events remain high in a Medicare population surviving >1 year after a MI. Continuing healthcare costs are doubled over pre- MI levels up to 5 years after an MI. Secondary prevention measures beyond the acute post- MI period may be indicated to reduce risk and cost in this chronic disease phase. [ABSTRACT FROM AUTHOR]

Background: Rehospitalizations after acute myocardial infarction for unplanned coronary revascularization and unstable angina (UA) are common. However, despite the inclusion of these events in composite end points of many clinical trials, their association with health status has not been studied.Methods and Results: We included 3283 patients with acute myocardial infarction enrolled in a prospective, 24-center US study who had rehospitalizations independently classified by experienced cardiologists. Health status was assessed using Seattle Angina Questionnaire and EuroQol-5D Visual Analog Scale. In the propensity-matched cohorts, 1-year health status was compared between those who did and did not experience rehospitalization for UA or revascularization using a hierarchical linear model. Overall, mean age was 59 years, 33% were women, and 70% were white. Rehospitalization rates for UA and unplanned revascularization at 1 year were 4.3% and 4.7%. One-year Seattle Angina Questionnaire summary scores were worse in patients with rehospitalizations for UA (mean difference, -10.1; 95% confidence interval, -12.4 to -7.9) and unplanned revascularization (mean difference, -5.7; 95% confidence interval, -8.8 to -2.5) when compared with patients without such rehospitalizations. Similarly, EuroQol-5D Visual Analog Scale scores were worse among patients with such readmissions. Individual Seattle Angina Questionnaire domains indicated worse 1-year angina and quality of life outcomes among patients rehospitalized for UA or unplanned revascularization.Conclusions: Within the first year after acute myocardial infarction, rehospitalizations for UA and unplanned revascularization are associated with worse health status. These findings highlight the impact of such events from a patient's perspective, beyond their economic impact and support the use of UA and unplanned revascularization as elements of composite end points. [ABSTRACT FROM AUTHOR]

In exploring the evolution and institutionalization of the White House chief of staff and the office that chiefs oversee, we focus on presidencies from Reagan through Obama. We pay particular attention to the evolution of several major roles that chiefs of staff perform, to the dynamics in the chief of staff's office, and to the emergence of multiple deputy chiefs of staff. Despite variation in the activities and emphases of chiefs of staff and their operations, patterns include partisan learning across administrations, term and meta cycles, and distinctive prioritization of roles. [ABSTRACT FROM AUTHOR]

Objectives: Recent studies have shown that the occurrence rate of bloodstream infections associated with arterial catheters is 0.9-3.4/1,000 catheter-days, which is comparable to that of central venous catheters. In 2011, the Centers for Disease Control and Prevention published new guidelines recommending the use of limited barrier precautions during arterial catheter insertion, consisting of sterile gloves, a surgical cap, a surgical mask, and a small sterile drape. The goal of this study was to assess the attitudes and current infection prevention practices used by clinicians during insertion of arterial catheters in ICUs in the United States. Design: An anonymous, 22-question web-based survey of infection prevention practices during arterial catheter insertion. Setting: Clinician members of the Society of Critical Care Medicine. Subjects: Eleven thousand three hundred sixty-one physicians, nurse practitioners, physician assistants, respiratory therapists, and registered nurses who elect to receive e-mails from the Society of Critical Care Medicine. Interventions: None. Measurements and Main Results: There were 1,265 responses (11% response rate), with 1,029 eligible participants after exclusions were applied. Only 44% of participants reported using the Centers for Disease Control and Prevention-recommended barrier precautions during arterial catheter insertion, and only 15% reported using full barrier precautions. The mean and median estimates of the incidence density of bloodstream infections associated with arterial catheters were 0.3/1,000 catheter-days and 0.1/1,000 catheter-days, respectively. Thirty-nine percent of participants reported that they would support mandatory use of full barrier precautions during arterial catheter insertion. Conclusions: Barrier precautions are used inconsistently by critical care clinicians during arterial catheter insertion in the ICU setting. Less than half of clinicians surveyed were in compliance with current Centers for Disease Control and Prevention guidelines. Clinicians significantly underestimated the infectious risk posed by arterial catheters, and support for mandatory use of full barrier precautions was low. Further studies are warranted to determine the optimal preventive strategies for reducing bloodstream infections associated with arterial catheters. [ABSTRACT FROM AUTHOR]

The article reflects on the issue of state-sponsored sex segregation in education with reference to the Supreme Court case Brown v. Board of Education. Topics discussed include the rise of single-sex schools and classes since the new the U.S Department of Education (ED) regulations in 2006, court cases decided by federal courts based on the constitutional doctrine of sex classifications and the harms that sex-segregated education causes. It also discusses the case United States v. Virginia.

The article focuses on cohort analysis performed to understand the association between bleeding and percutaneous coronary intervention (PCI) and subsequent association with increased morbidity and health care costs. Post procedural bleeding is associated with nonfatal myocardial infraction, blood transfusion and stroke. The study was conducted on CathPCI registry performed in the U.S. between 2004 - 2011. The results obtained showed that in-hospitality mortality rate increased with increase in number of post procedural bleeding events in PCI-registered patients.

Objectives This article examines the roles, responsibilities, and performance of the first two White House chiefs of staff during the Obama administration: Rahm Emanuel and William Daley. Methods Data are drawn and analyzed from academic and media resources, original interviews conducted by the authors with former staff in the Obama White House, and public documents. Results Perhaps the most high-profile chief of staff in history, Rahm Emanuel was an important, but at times, ineffective advisor to, and proxy of, the president. He also served as a sturdy guardian, despite evident disagreement on policy priorities and strategies. His focus on shorter term tactics and his weakness as an honest broker negatively impacted the Obama administration. Emanuel's successor, William Daley, initially brought needed discipline and focus to a White House riven by factions. Daley, however, lasted only a year as he never fully adjusted to the demands of the job nor did he appear to fully appreciate the depth of the partisan polarization and hostility in Washington. Conclusion The Obama administration's first two chiefs of staff had to navigate a challenging environment in an administration filled with strong personalities and tested by events including the financial crisis and recession, passage of the health-care legislation, the 2010 midterm election debacle, the debt-ceiling crisis, and a number of foreign policy challenges in the Middle East, North Africa, and Afghanistan. Though very different in terms of personality, style, and the roles they emphasized during their tenures, both chiefs of staff were largely ineffective, thus diminishing the performance of the president and administration. [ABSTRACT FROM AUTHOR]

In an effort to examine the causal determinants of performance dynamics for the administrative presidency, the authors apply empirical public management theory to White House administration to explain managerial performance. Utilizing original survey data that measure the perceptions of former officials from the Reagan, George H. W. Bush, and Clinton administrations, we conduct quantitative analyses to determine the extent to which a chief of staff’s background, relationship with the president, and internal as well as external management approaches shape overall perceptions of White House administrative efforts. The authors find that managerial dimensions matter considerably when explaining the dynamics of White House organizational performance. [ABSTRACT FROM PUBLISHER]

The article presents a study that investigated outcomes and costs among unselected patients with medically managed severe, symptomatic aortic stenosis (AS) from the perspective of the U.S. Medicare Program. Methods are presented involving outcome measures, risk stratification and adjustment, and statistical analysis. Results are discussed in terms of patient population, resource use and costs, and clinical outcomes.

An interview with U.S. Treasury Department Under Secretary David Cohen is presented. He comments on how the Treasury's role in addressing terrorist threats has evolved. He discusses the Treasury's efforts and successes in targeting donors and fundraisers for terrorist groups. He relates the ways by which the U.S. is encouraging foreign countries and corporations to cooperate in disrupting terrorism financing and imposing sanctions.

The article discusses a study to assess variations in drug-eluting stents (DES) use among U.S. physicians participating in the National Cardiovascular Data Registry (NCDR), the association between predicted target vessel revascularization (TVR) risk with bare-metal stents (BMS) with DES use and the estimated clinical and economic consequences of lower DES use in patients with low TVR risk. It concludes that DES use is common even on those predicted to be at the lowest restenosis risk.

The article focuses on the U.S. Supreme Court case McDonald v. City of Chicago, which dealt with the U.S. Constitution's Second Amendment right to bear arms. Topics include an individual's right to possess a gun for self-defense purposes, gun and firearm laws in the U.S., and the constitutionality of banning weaponry in the U.S.

The article discusses the organization, evolution, and political and legislative history of the U.S. homeland security operation in the White House since the September 11, 2001, terrorist attacks against the U.S. It examines decisions by the administration of U.S. president Barack Obama to restructure the White House Homeland Security Council (HSC) within the purview of the U.S. National Security Council (NSC). The authors argue that the restructuring of the homeland security apparatus by the Obama administration was a mistake due to rising threats of the risks of natural disasters, the preference of terrorism security over natural disaster security by the U.S. bureaucracy, and the political considerations of homeland security as opposed to national security and counter-terrorism efforts.