Infective Endocarditis in the U.S., 1998–2009: A Nationwide Study

Background: Previous studies based on local case series estimated the annual incidence of endocarditis in the U.S. at about 4 per 100,000 population. Small-scale studies elsewhere have reported similar incidence rates. However, no nationally-representative population-based studies have verified these estimates. Methods and findings: Using the 1998–2009 Nationwide Inpatient Sample, which provides diagnoses from about 8 million U.S. hospitalizations annually, we examined endocarditis hospitalizations, bacteriology, co-morbidities, outcomes and costs. Hospital admissions for endocarditis rose from 25,511 in 1998 to 38, 976 in 2009 (12.7 per 100,000 population in 2009). The age-adjusted endocarditis admission rate increased 2.4% annually. The proportion of patients with intra-cardiac devices rose from 13.3% to 18.9%, while the share with drug use and/or HIV fell. Mortality remained stable at about 14.5%, as did cardiac valve replacement (9.6%). Other serious complications increased; 13.3% of patients in 2009 suffered a stroke or CNS infection, and 5.5% suffered myocardial infarction. Amongst cases with identified pathogens, Staphylococcus aureus was the most common, increasing from 37.6% in 1998 to 49.3% in 2009, 53.3% of which were MRSA. Streptococci were mentioned in 24.7% of cases, gram-negatives in 5.6% and Candida species in 1.0%. We detected no inflection in hospitalization rates after changes in prophylaxis recommendations in 2007. Mean age rose from 58.6 to 60.8 years; elderly patients suffered higher rates of myocardial infarction and death, but slightly lower rates of Staphylococcus aureus infections and neurologic complications. Our study relied on clinically diagnosed cases of endocarditis that may not meet strict criteria. Moreover, since some patients are discharged and readmitted during a single episode of endocarditis, our hospitalization figures probably slightly overstate the true incidence of this illness. Conclusions: Endocarditis is more common in the U.S. than previously believed, and is steadily increasing. Preventive efforts should focus on device-associated and health-care-associated infections

Higher Education Exchange: 2008

This annual publication serves as a forum for new ideas and dialogue between scholars and the larger public. Essays explore ways that students, administrators, and faculty can initiate and sustain an ongoing conversation about the public life they share.The Higher Education Exchange is founded on a thought articulated by Thomas Jefferson in 1820: "I know no safe depository of the ultimate powers of the society but the people themselves; and if we think them not enlightened enough to exercise their control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education."In the tradition of Jefferson, the Higher Education Exchange agrees that a central goal of higher education is to help make democracy possible by preparing citizens for public life. The Higher Education Exchange is part of a movement to strengthen higher education's democratic mission and foster a more democratic culture throughout American society.Working in this tradition, the Higher Education Exchange publishes interviews, case studies, analyses, news, and ideas about efforts within higher education to develop more democratic societies

Strategic Geography and the Greater Middle East

Daily events in the Middle East, North Africa, the African Horn, South Asia, and ex-Soviet Central Asia offer little encouragement that this region is at the “end of history”—the end of major warfare and security rivalries. Two Gulf wars have been fought in recent memory, as well as Arab-Israeli and Indian-Pakistani wars. In that obvious sense, geopolitics is alive and well in the Greater Middle East

Picking Our Battles: A Strategy for the United States in the Wake of Mexico\u27s Becoming a State Party to the International Criminal Court

When Mexico became a state party to the International Criminal Court, it put the United States in the position of choosing between honoring its relationship with Mexico or staying true to its strong objections to the ICC. The downside of the first option is that the United States would be backing down from its anti-ICC stance; the downside of the latter is that the United States would not only disrespect Mexico in pushing it to sign a bilateral immunity agreement, but, since Mexico would likely refuse to enter into such an agreement, the United States would also be put in the awkward position of having to cut off foreign aid to Mexico in areas where cooperation is both frequent and productive, such as trade, combating drug trafficking, and fighting terrorism. Given the importance of its cooperative relationship with Mexico and the argument that most U.S. objections to the ICC can be countered with safeguards in the Court\u27s framework, the United States should choose to rely on the safeguards built into the ICC, not pursue a bilateral immunity agreement with Mexico, and continue to provide military and other foreign aid to Mexico

Thinking about Basing

Recent U.S. experiences—1990–91 in the Persian Gulf, in Bosnia, Kosovo, and then in Afghanistan (2001) and Iraq (2003)—have highlighted the complexities and uncertainties of basing access in the post–Cold War period. They have involved questions of access to, and overhead transit rights for, a variety of nations: all over Europe, Egypt, Turkey, Saudi Arabia, Qatar, Tadzhikistan, Kyrgyzstan, Djibouti, and many others. They have also highlighted the crucial importance of the future of American basing access at a time of shifting alli- ances, friendships, and enmities amid wholesale changes in the structure of the international system, and of the movement to the forefront of the issues of ter- rorism, radical Islam, proliferation of weapons of mass destruction, and a loom- ing hegemonic challenge by China

The Civic Engagement Movement and the Democratization of the Academy

General book summary: Diverse essays create a new definition of leadership education based in colleges and universities The essays in this volume address the idea of leadership education through civic engagement. They delineate a new approach to leadership education reflecting important cultural trends driven by technology, globalization, and demographic shifts; look at some of the best leadership education programs nationwide; and offer “next steps” on how to transform higher education more broadly

De-Platonizing and Democratizing Education as the Bases of Service Learning

The theoretical bases of academic service learning are examined, with particular attention to John Dewey’s contributions. The service learning movement is conceptualized as part of an ongoing—and still unsuccessful—effort to “de-Platonize” and democratize American higher education in particular and American schooling in general