Morocco's experience suggests that expanded political liberty, especially freedom of association, can facilitate the emergence of multiple versions of political Islam, reducing the salience of a large, undifferentiated Islamist movement as an umbrella for oppositionist sentiment. The best means for containing potentially destabilizing discontent and promoting moderation among potentially antidemocratic forces are a pluralized political space and iterative free elections. The dilemmas that the king must now resolve in the face of citizen alienation reveal the limits of a strategy of gradual liberalization stage-managed from on high by a pro-Western autocrat.

Abstract

The authors examined how the association between quality improvement (QI) implementation in hospitals and hospital clinical quality is moderated by hospital organizational and environmental context. The authors used Ordinary Least Squares regression analysis of 1,784 community hospitals to model seven quality indicators as a function of four measures of QI implementation and a variety of control variables. They found that forces that are external and internal to the hospital condition the impact of particular QI activities on quality indicators: specifically data use, statistical tool use, and organizational emphasis on Continuous Quality Improvement (CQI). Results supported the proposition that QI implementation is unlikely to improve quality of care in hospital settings without a commensurate fit with the financial, strategic, and market imperatives faced by the hospital.

The terrible wake-up call of 9/11 brought homeland security and homeland defense into full focus for a nation ill-prepared for the threat of transnational terrorism. Our nation has done much to meet that threat, yet much more still needs to be done. Balancing security concerns against those of individual liberties, ensuring parallel commitments to law enforcement and defense remain complementary but distinct, are just two of the issues of concern. In this spirit, the U.S. Army War College’s Center for Strategic Leadership partnered with The George Washington University, the Center for Strategic and International Studies, and the Heritage Foundation to conduct the first annual Homeland Defense/Homeland Security conference. The conference was an ambitious endeavor, designed to draw on a cross-section of experience from the partner institutions, their supporters, and their audiences in addressing the issues at hand. This volume is a reflection of those discussions.

Black patients receiving dialysis for end-stage renal disease in the United States have lower mortality rates than white patients. Whether racial differences exist in mortality after acute renal failure is not known. We studied acute renal failure in patients hospitalized between 2000 and 2003 using the Nationwide Inpatient Sample and found that black patients had an 18% (95% confidence interval [CI] 16 to 21%) lower odds of death than white patients after adjusting for age, sex, comorbidity, and the need for mechanical ventilation. Similarly, among those with acute renal failure requiring dialysis, black patients had a 16% (95% CI 10 to 22%) lower odds of death than white patients. In stratified analyses of patients with acute renal failure, black patients had significantly lower adjusted odds of death than white patients in settings of coronary artery bypass grafting, cardiac catheterization, acute myocardial infarction, congestive heart failure, pneumonia, sepsis, and gastrointestinal hemorrhage. Black patients were more likely than white patients to be treated in hospitals that care for a larger number of patients with acute renal failure, and black patients had lower in-hospital mortality than white patients in all four quartiles of hospital volume. In conclusion, in-hospital mortality is lower for black patients with acute renal failure than white patients. Future studies should assess the reasons for this difference.

Observers often note the glaring contrast between China's stunning economic progress and stalled political reforms. Although sustained growth in GNP has not brought democratization at the national level, this does not mean that the Chinese political system has remained unchanged. At the grassroots level, a number of important reforms have been implemented in the last two decades.

This volume, written by scholars who have undertaken substantial fieldwork in China, explores a range of grassroots efforts--initiated by the state and society alike--intended to restrain arbitrary and corrupt official behavior and enhance the accountability of local authorities. Topics include village and township elections, fiscal reforms, legal aid, media supervision, informal associations, and popular protests. While the authors offer varying assessments of the larger significance of these developments, their case studies point to a more dynamic Chinese political system than is often acknowledged. When placed in historical context--as in the Introduction--we see that reforms in local governance are hardly a new feature of Chinese political statecraft and that the future of these experiments is anything but certain.

Background: Women with acute myocardial infarction have a higher hospital mortality rate than men. This difference has been ascribed to their older age, more frequent comorbidities, and less frequent use of revascularization. The aim of this study is to assess these factors in relation to excess mortality in women.

Methods and Results All hospital admissions in France with a discharge diagnosis of acute myocardial infarction were extracted from the national payment database. Logistic regression on mortality was performed for age, comorbidities, and coronary interventions. Nonparametric microsimulation models estimated the percutaneous coronary intervention and mortality rates that women would experience if they were "treated like men." Data were analyzed from 74 389 patients hospitalized with acute myocardial infarction, 30.0% of whom were women. Women were older (75 versus 63 years of age; P0.001) and had a higher rate of hospital mortality (14.8% versus 6.1%; P0.0001) than men. Percutaneous coronary interventions were more frequent in men (7.4% versus 4.8%; 24.4% versus 14.2% with stent; P0.001). Mortality adjusted for age and comorbidities was higher in women (P0.001), with an excess adjusted absolute mortality of 1.95%. Simulation models related 0.46% of this excess to reduced use of procedures. Survival benefit related to percutaneous coronary intervention was lower among women.

Conclusions The difference in mortality rate between men and women with acute myocardial infarction is due largely to the different age structure of these populations. However, age-adjusted hospital mortality was higher for women and was associated with a lower rate of percutaneous coronary intervention. Simulations suggest that women would derive benefit from more frequent use of percutaneous coronary intervention, although these procedures appear less protective in women than in men.