David G. Williams

Organic planning: A new approach to public participation in local governance

Abstract In the past few years, a new form of citizen-oriented policy deliberation has emerged. Often using the concept of “visioning” as a vehicle, efforts have been carried out to foster citizen discussions regarding the desired future of a community, region, or jurisdiction. The future orientation of such deliberations allows for a wide array of issues and concerns to be identified and acted upon in a developmental format. This paper seeks to draw some generalizations from this new phenomena. We argue that this is a new form of citizen participation that builds upon, but is distinct from, previous citizen participation practices and models. We call this new variant organic planning .

C-reactive protein and brain natriuretic peptide as predictors of adverse events after lower extremity endovascular revascularization

BACKGROUND High-sensitivity C-reactive protein (hsCRP) and brain natriuretic peptide (BNP) have been shown to be independent predictors of adverse cardiovascular outcomes and increased risk of secondary interventions or limb loss in patients with peripheral arterial disease (PAD). To assist clinicians in decision-making about treatment approaches and predicting postprocedure mortality and morbidity, we retrospectively examined patients with preprocedure hsCRP and BNP levels who underwent elective angioplasty or stent placement for lower extremity PAD. METHODS The study period was from January 1, 2007, to December 31, 2012, and patients were included who had angioplasty or stenting for PAD. Minimal required follow-up for study inclusion was at least one postoperative ankle-brachial index, contrast angiography, or duplex imaging of the treated limb. Events of interest included major adverse limb events (MALE), defined as target vessel revascularization, amputation, or disease progression by 1 year, and major adverse cardiovascular events (MACE; stroke, myocardial infarction, or death) by 2 years. Elevated/abnormal values for our biomarkers of interest were established by the upper limits of our institutions clinical laboratory reference range (hsCRP, >0.80 mg/dL; BNP, >100 pg/mL). RESULTS A total of 159 limbs in 118 patients were included in analysis (42% men; median age [range], 64 [42-87] years). All limbs were symptomatic (Rutherford classification: 1-6). Iliac artery revascularization without other adjunct lower extremity intervention was performed in 60% of the limbs. High hsCRP levels (>0.80 mg/dL) were present in 32 patients (27%) and high BNP values (>100 pg/mL) in 24 patients (20%). Kaplan-Meier analysis with log-rank comparison demonstrated that elevated hsCRP levels were associated with MALE but only in limbs receiving interventions distal to the iliac arteries (P = .005). High BNP levels did not affect MALE rates (P = .821). Conversely, both elevated BNP levels (hazard ratio, 5.6; 95% confidence interval [CI], 2.0-5.8; P = .001) and hsCRP levels (hazard ratio, 2.9; 95% CI, 1.1-7.6; P = .034) predicted MACE at 2 years in the presence of confounders in Cox proportional hazards multivariate analysis. Patients with high preintervention values of hsCRP and BNP were 10.6 times (95% CI, 2.6-42.9; P = .001) more likely to experience MACE than were patients with normal hsCRP and BNP values. CONCLUSIONS After lower extremity endovascular interventions, elevated preprocedural hsCRP levels are associated with MALE (femoral-popliteal interventions), and elevated levels of hsCRP and BNP are associated with late cardiovascular events.

Seeking the Holy Grail: Assessing Outcomes of MPA Programs

Abstract NASPAA accreditation standards, university assessment processes, and program management have put an increased emphasis on outcome and performance measurement in MPA and related programs. Simple yet comprehensive measures are not easily found or are very difficult and expensive to create. Based on the trade-offs, this article proposes information that may be collected as a byproduct of MPA program operation and from supplemental processes. Use of these multiple measures can serve well in assessing MPA programs and in guiding their performance. Examples are given from a specific MPA program.

Making Engagement Work: University Outreach and Welfare Reform in West Virginia

Abstract Much attention has been given to the concept of the “engaged university” that seeks to reaffirm the role of higher education in serving society through outreach, teaching, and research. Higher education commissions and associations, as well as individual institutions, have endorsed efforts to connect higher education with society through outreach and applied research. Salient policy issues, which have a direct bearing on institutions of higher learning and frame questions that are ripe for university response, help to sharpen the role of university engagement. Welfare reform is such an issue. This article explores how some of the dimensions of university engagement have been put into operation through a case study of West Virginia Universitys response to welfare reform. It gives attention to some of the barriers and obstacles to engagement and emphasizes that public administration and affairs faculty may be well-placed to facilitate outreach and to incorporate service activities in teaching and research. The article recommends that institutions help orient faculty to areas of societal and policy concern and need, rather than closely direct outreach activities. The article also stresses the importance of interdisciplinary effort and emphasizes the need for finding connections between teaching, research, and service.

Applying Public Management Concepts to Ourselves: Accreditation Under the New Master Degree Mission Standards.

What does the recent shift to mission based assessment for accreditation mean for public administration education? What influence does it appear to have on programs? Does the new focus on program mission make it harder or easier to be accredited? What can be learned from the first three years of mission accreditation? What kinds of missions, outcomes and assessment processes will successfully meet review by the Commission on Peer Review and Accreditation (COPRA)?

Biochemical markers in patients with open reconstructions with peripheral arterial disease

The purpose of our study was to determine outcome differences as a function of baseline high-sensitivity C-reactive protein (hsCRP) and B-type natriuretic peptide (BNP) levels in patients receiving lower extremity open reconstructions for the treatment of peripheral arterial occlusive disease. We retrospectively examined patients who underwent surgical reconstructions performed by a single operator during a seven-year time span who received preoperative hsCRP and BNP testing and post-procedure imaging. Outcomes of interest included major adverse limb events, a composite end point of target vessel revascularization, limb amputation, and disease progression, and major adverse cardiovascular events comprised of stroke, myocardial infarction, and death. A total of 89 limbs in 82 patients were included in analysis. Multivariate analysis demonstrated that higher hsCRP levels (>3.0 mg/L) trended toward, but failed to significantly associate with major adverse limb events at 24 months (hazard ratio: 2.2 [1.0–5.2], p = 0.06), however the use of a vein bypass conduit (vs. prosthetic reconstruction) significantly predicted major adverse limb events (hazard ratio: 3.2 [1.5–6.9], p < 0.01). Elevated BNP levels (>100 pg/ml), but not hsCRP, associated with major adverse cardiovascular events (hazard ratio: 3.5 [1.2–10.3], p = 0.03). Preoperative biochemical markers may assist in clinical decision making and stratifying patients regarding adverse events following open reconstructions.