48 results
4 Evaluating Plasma GFAP for the Detection of Alzheimer’s Disease Dementia
- Madeline Ally, Henrik Zetterberg, Kaj Blennow, Nicholas J. Ashton, Thomas K. Karikari, Hugo Aparicio, Michael A. Sugarman, Brandon Frank, Yorghos Tripodis, Ann C. McKee, Thor D. Stein, Brett Martin, Joseph N. Palmisano, Eric G. Steinberg, Irene Simkina, Lindsay Farrer, Gyungah Jun, Katherine W. Turk, Andrew E. Budson, Maureen K. O’Connor, Rhoda Au, Wei Qiao Qiu, Lee E. Goldstein, Ronald Killiany, Neil W. Kowall, Robert A. Stern, Jesse Mez, Michael L. Alosco
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 408-409
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Objective:
Blood-based biomarkers represent a scalable and accessible approach for the detection and monitoring of Alzheimer’s disease (AD). Plasma phosphorylated tau (p-tau) and neurofilament light (NfL) are validated biomarkers for the detection of tau and neurodegenerative brain changes in AD, respectively. There is now emphasis to expand beyond these markers to detect and provide insight into the pathophysiological processes of AD. To this end, a reactive astrocytic marker, namely plasma glial fibrillary acidic protein (GFAP), has been of interest. Yet, little is known about the relationship between plasma GFAP and AD. Here, we examined the association between plasma GFAP, diagnostic status, and neuropsychological test performance. Diagnostic accuracy of plasma GFAP was compared with plasma measures of p-tau181 and NfL.
Participants and Methods:This sample included 567 participants from the Boston University (BU) Alzheimer’s Disease Research Center (ADRC) Longitudinal Clinical Core Registry, including individuals with normal cognition (n=234), mild cognitive impairment (MCI) (n=180), and AD dementia (n=153). The sample included all participants who had a blood draw. Participants completed a comprehensive neuropsychological battery (sample sizes across tests varied due to missingness). Diagnoses were adjudicated during multidisciplinary diagnostic consensus conferences. Plasma samples were analyzed using the Simoa platform. Binary logistic regression analyses tested the association between GFAP levels and diagnostic status (i.e., cognitively impaired due to AD versus unimpaired), controlling for age, sex, race, education, and APOE e4 status. Area under the curve (AUC) statistics from receiver operating characteristics (ROC) using predicted probabilities from binary logistic regression examined the ability of plasma GFAP to discriminate diagnostic groups compared with plasma p-tau181 and NfL. Linear regression models tested the association between plasma GFAP and neuropsychological test performance, accounting for the above covariates.
Results:The mean (SD) age of the sample was 74.34 (7.54), 319 (56.3%) were female, 75 (13.2%) were Black, and 223 (39.3%) were APOE e4 carriers. Higher GFAP concentrations were associated with increased odds for having cognitive impairment (GFAP z-score transformed: OR=2.233, 95% CI [1.609, 3.099], p<0.001; non-z-transformed: OR=1.004, 95% CI [1.002, 1.006], p<0.001). ROC analyses, comprising of GFAP and the above covariates, showed plasma GFAP discriminated the cognitively impaired from unimpaired (AUC=0.75) and was similar, but slightly superior, to plasma p-tau181 (AUC=0.74) and plasma NfL (AUC=0.74). A joint panel of the plasma markers had greatest discrimination accuracy (AUC=0.76). Linear regression analyses showed that higher GFAP levels were associated with worse performance on neuropsychological tests assessing global cognition, attention, executive functioning, episodic memory, and language abilities (ps<0.001) as well as higher CDR Sum of Boxes (p<0.001).
Conclusions:Higher plasma GFAP levels differentiated participants with cognitive impairment from those with normal cognition and were associated with worse performance on all neuropsychological tests assessed. GFAP had similar accuracy in detecting those with cognitive impairment compared with p-tau181 and NfL, however, a panel of all three biomarkers was optimal. These results support the utility of plasma GFAP in AD detection and suggest the pathological processes it represents might play an integral role in the pathogenesis of AD.
4 Risk Factor and Biomarker Correlates of FLAIR White Matter Hyperintensities in Former American Football Players
- Monica T Ly, Fatima Tuz-Zahra, Yorghos Tripodis, Charles H Adler, Laura J Balcer, Charles Bernick, Elaine Peskind, Megan L Mariani, Rhoda Au, Sarah J Banks, William B Barr, Jennifer V Wethe, Mark W Bondi, Lisa Delano-Wood, Robert C Cantu, Michael J Coleman, David W Dodick, Michael D McClean, Jesse Mez, Joseph N Palmisano, Brett Martin, Kaitlin Hartlage, Alexander P Lin, Inga K Koerte, Jeffrey L Cummings, Eric M Reiman, Martha E Shenton, Robert A Stern, Sylvain Bouix, Michael L Alosco
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 608-610
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Objective:
White matter hyperintensity (WMH) burden is greater, has a frontal-temporal distribution, and is associated with proxies of exposure to repetitive head impacts (RHI) in former American football players. These findings suggest that in the context of RHI, WMH might have unique etiologies that extend beyond those of vascular risk factors and normal aging processes. The objective of this study was to evaluate the correlates of WMH in former elite American football players. We examined markers of amyloid, tau, neurodegeneration, inflammation, axonal injury, and vascular health and their relationships to WMH. A group of age-matched asymptomatic men without a history of RHI was included to determine the specificity of the relationships observed in the former football players.
Participants and Methods:240 male participants aged 45-74 (60 unexposed asymptomatic men, 60 male former college football players, 120 male former professional football players) underwent semi-structured clinical interviews, magnetic resonance imaging (structural T1, T2 FLAIR, and diffusion tensor imaging), and lumbar puncture to collect cerebrospinal fluid (CSF) biomarkers as part of the DIAGNOSE CTE Research Project. Total WMH lesion volumes (TLV) were estimated using the Lesion Prediction Algorithm from the Lesion Segmentation Toolbox. Structural equation modeling, using Full-Information Maximum Likelihood (FIML) to account for missing values, examined the associations between log-TLV and the following variables: total cortical thickness, whole-brain average fractional anisotropy (FA), CSF amyloid ß42, CSF p-tau181, CSF sTREM2 (a marker of microglial activation), CSF neurofilament light (NfL), and the modified Framingham stroke risk profile (rFSRP). Covariates included age, race, education, APOE z4 carrier status, and evaluation site. Bootstrapped 95% confidence intervals assessed statistical significance. Models were performed separately for football players (college and professional players pooled; n=180) and the unexposed men (n=60). Due to differences in sample size, estimates were compared and were considered different if the percent change in the estimates exceeded 10%.
Results:In the former football players (mean age=57.2, 34% Black, 29% APOE e4 carrier), reduced cortical thickness (B=-0.25, 95% CI [0.45, -0.08]), lower average FA (B=-0.27, 95% CI [-0.41, -.12]), higher p-tau181 (B=0.17, 95% CI [0.02, 0.43]), and higher rFSRP score (B=0.27, 95% CI [0.08, 0.42]) were associated with greater log-TLV. Compared to the unexposed men, substantial differences in estimates were observed for rFSRP (Bcontrol=0.02, Bfootball=0.27, 994% difference), average FA (Bcontrol=-0.03, Bfootball=-0.27, 802% difference), and p-tau181 (Bcontrol=-0.31, Bfootball=0.17, -155% difference). In the former football players, rFSRP showed a stronger positive association and average FA showed a stronger negative association with WMH compared to unexposed men. The effect of WMH on cortical thickness was similar between the two groups (Bcontrol=-0.27, Bfootball=-0.25, 7% difference).
Conclusions:These results suggest that the risk factor and biological correlates of WMH differ between former American football players and asymptomatic individuals unexposed to RHI. In addition to vascular risk factors, white matter integrity on DTI showed a stronger relationship with WMH burden in the former football players. FLAIR WMH serves as a promising measure to further investigate the late multifactorial pathologies of RHI.
5 Antemortem Plasma GFAP Predicts Alzheimer’s Disease Neuropathological Changes
- Madeline Ally, Henrik Zetterberg, Kaj Blennow, Nicholas J. Ashton, Thomas K. Karikari, Hugo Aparicio, Michael A. Sugarman, Brandon Frank, Yorghos Tripodis, Brett Martin, Joseph N. Palmisano, Eric G. Steinberg, Irene Simkina, Lindsay Farrer, Gyungah Jun, Katherine W. Turk, Andrew E. Budson, Maureen K. O’Connor, Rhoda Au, Wei Qiao Qiu, Lee E. Goldstein, Ronald Killiany, Neil W. Kowall, Robert A. Stern, Jesse Mez, Bertran R. Huber, Ann C. McKee, Thor D. Stein, Michael L. Alosco
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 409-410
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Objective:
Blood-based biomarkers offer a more feasible alternative to Alzheimer’s disease (AD) detection, management, and study of disease mechanisms than current in vivo measures. Given their novelty, these plasma biomarkers must be assessed against postmortem neuropathological outcomes for validation. Research has shown utility in plasma markers of the proposed AT(N) framework, however recent studies have stressed the importance of expanding this framework to include other pathways. There is promising data supporting the usefulness of plasma glial fibrillary acidic protein (GFAP) in AD, but GFAP-to-autopsy studies are limited. Here, we tested the association between plasma GFAP and AD-related neuropathological outcomes in participants from the Boston University (BU) Alzheimer’s Disease Research Center (ADRC).
Participants and Methods:This sample included 45 participants from the BU ADRC who had a plasma sample within 5 years of death and donated their brain for neuropathological examination. Most recent plasma samples were analyzed using the Simoa platform. Neuropathological examinations followed the National Alzheimer’s Coordinating Center procedures and diagnostic criteria. The NIA-Reagan Institute criteria were used for the neuropathological diagnosis of AD. Measures of GFAP were log-transformed. Binary logistic regression analyses tested the association between GFAP and autopsy-confirmed AD status, as well as with semi-quantitative ratings of regional atrophy (none/mild versus moderate/severe) using binary logistic regression. Ordinal logistic regression analyses tested the association between plasma GFAP and Braak stage and CERAD neuritic plaque score. Area under the curve (AUC) statistics from receiver operating characteristics (ROC) using predicted probabilities from binary logistic regression examined the ability of plasma GFAP to discriminate autopsy-confirmed AD status. All analyses controlled for sex, age at death, years between last blood draw and death, and APOE e4 status.
Results:Of the 45 brain donors, 29 (64.4%) had autopsy-confirmed AD. The mean (SD) age of the sample at the time of blood draw was 80.76 (8.58) and there were 2.80 (1.16) years between the last blood draw and death. The sample included 20 (44.4%) females, 41 (91.1%) were White, and 20 (44.4%) were APOE e4 carriers. Higher GFAP concentrations were associated with increased odds for having autopsy-confirmed AD (OR=14.12, 95% CI [2.00, 99.88], p=0.008). ROC analysis showed plasma GFAP accurately discriminated those with and without autopsy-confirmed AD on its own (AUC=0.75) and strengthened as the above covariates were added to the model (AUC=0.81). Increases in GFAP levels corresponded to increases in Braak stage (OR=2.39, 95% CI [0.71-4.07], p=0.005), but not CERAD ratings (OR=1.24, 95% CI [0.004, 2.49], p=0.051). Higher GFAP levels were associated with greater temporal lobe atrophy (OR=10.27, 95% CI [1.53,69.15], p=0.017), but this was not observed with any other regions.
Conclusions:The current results show that antemortem plasma GFAP is associated with non-specific AD neuropathological changes at autopsy. Plasma GFAP could be a useful and practical biomarker for assisting in the detection of AD-related changes, as well as for study of disease mechanisms.
A data mining approach to investigate food groups related to incidence of bladder cancer in the BLadder cancer Epidemiology and Nutritional Determinants International Study
- Evan Y. W. Yu, Anke Wesselius, Christoph Sinhart, Alicja Wolk, Mariana Carla Stern, Xuejuan Jiang, Li Tang, James Marshall, Eliane Kellen, Piet van den Brandt, Chih-Ming Lu, Hermann Pohlabeln, Gunnar Steineck, Mohamed Farouk Allam, Margaret R. Karagas, Carlo La Vecchia, Stefano Porru, Angela Carta, Klaus Golka, Kenneth C. Johnson, Simone Benhamou, Zuo-Feng Zhang, Cristina Bosetti, Jack A. Taylor, Elisabete Weiderpass, Eric J. Grant, Emily White, Jerry Polesel, Maurice P. A. Zeegers
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- Journal:
- British Journal of Nutrition / Volume 124 / Issue 6 / 28 September 2020
- Published online by Cambridge University Press:
- 23 April 2020, pp. 611-619
- Print publication:
- 28 September 2020
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At present, analysis of diet and bladder cancer (BC) is mostly based on the intake of individual foods. The examination of food combinations provides a scope to deal with the complexity and unpredictability of the diet and aims to overcome the limitations of the study of nutrients and foods in isolation. This article aims to demonstrate the usability of supervised data mining methods to extract the food groups related to BC. In order to derive key food groups associated with BC risk, we applied the data mining technique C5.0 with 10-fold cross-validation in the BLadder cancer Epidemiology and Nutritional Determinants study, including data from eighteen case–control and one nested case–cohort study, compromising 8320 BC cases out of 31 551 participants. Dietary data, on the eleven main food groups of the Eurocode 2 Core classification codebook, and relevant non-diet data (i.e. sex, age and smoking status) were available. Primarily, five key food groups were extracted; in order of importance, beverages (non-milk); grains and grain products; vegetables and vegetable products; fats, oils and their products; meats and meat products were associated with BC risk. Since these food groups are corresponded with previously proposed BC-related dietary factors, data mining seems to be a promising technique in the field of nutritional epidemiology and deserves further examination.
Differentiating Between Healthy Control Participants and Those with Mild Cognitive Impairment Using Volumetric MRI Data
- Renée DeVivo, Lauren Zajac, Asim Mian, Anna Cervantes-Arslanian, Eric Steinberg, Michael L. Alosco, Jesse Mez, Robert Stern, Ronald Killany, for the Alzheimer’s Disease Neuroimaging Initiative
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- Journal:
- Journal of the International Neuropsychological Society / Volume 25 / Issue 8 / September 2019
- Published online by Cambridge University Press:
- 27 May 2019, pp. 800-810
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Objective: To determine whether volumetric measures of the hippocampus, entorhinal cortex, and other cortical measures can differentiate between cognitively normal individuals and subjects with mild cognitive impairment (MCI). Method: Magnetic resonance imaging (MRI) data from 46 cognitively normal subjects and 50 subjects with MCI as part of the Boston University Alzheimer’s Disease Center research registry and the Alzheimer’s Disease Neuroimaging Initiative were used in this cross-sectional study. Cortical, subcortical, and hippocampal subfield volumes were generated from each subject’s MRI data using FreeSurfer v6.0. Nominal logistic regression models containing these variables were used to identify subjects as control or MCI. Results: A model containing regions of interest (superior temporal cortex, caudal anterior cingulate, pars opercularis, subiculum, precentral cortex, caudal middle frontal cortex, rostral middle frontal cortex, pars orbitalis, middle temporal cortex, insula, banks of the superior temporal sulcus, parasubiculum, paracentral lobule) fit the data best (R2 = .7310, whole model test chi-square = 97.16, p < .0001). Conclusions: MRI data correctly classified most subjects using measures of selected medial temporal lobe structures in combination with those from other cortical areas, yielding an overall classification accuracy of 93.75%. These findings support the notion that, while volumes of medial temporal lobe regions differ between cognitively normal and MCI subjects, differences that can be used to distinguish between these two populations are present elsewhere in the brain.
Development and testing of the FRESH Foods Survey to assess food pantry clients’ dietary behaviours and correlates
- Eric E Calloway, Hilary K Seligman, Lisa W Boyd, Katie L Stern, Sophie Rosenmoss, Amy L Yaroch
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- Journal:
- Public Health Nutrition / Volume 22 / Issue 12 / August 2019
- Published online by Cambridge University Press:
- 21 May 2019, pp. 2170-2178
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Objective:
To use cognitive interviewing and pilot testing to develop a survey instrument feasible for administering in the food pantry setting to assess daily intake frequency from several major food groups and dietary correlates (e.g. fruit and vegetable barriers) – the FRESH Foods Survey.
Design:New and existing survey items were adapted and refined following cognitive interviews. After piloting the survey with food pantry users in the USA, preliminary psychometric and construct validity analyses were performed.
Setting:Three US food banks and accompanying food pantries in Atlanta, GA, San Diego, CA, and Buffalo, NY.
Participants:Food pantry clients (n 246), mostly female (68 %), mean age 54·5 (sd 14·7) years.
Results:Measures of dietary correlates performed well psychometrically: Cronbach’s α range 0·71–0·90, slope (α) parameter range 1·26–6·36, and threshold parameters (β) indicated variability in the ‘difficulty’ of the items. Additionally, all scales had only one eigenvalue above 1·0 (range 2·07–4·71), indicating unidimensionality. Average (median, Q1–Q3) daily intakes (times/d) across six dietary groups were: fruits and vegetables (2·87, 1·87–4·58); junk foods (1·16, 0·58–2·16); fast foods and similar entrées (1·45, 0·58–2·03); whole-grain foods (0·87, 0·58–1·71); sugar-sweetened beverages (0·58, 0·29–1·29); milk and milk alternatives (0·71, 0·29–1·29). Significant correlations between dietary groups and dietary correlates were largely in the directions expected based on the literature, giving initial indication of convergent and discriminant validity.
Conclusions:The FRESH Foods Survey is efficient, tailored to food pantry populations, can be used to monitor dietary behaviours and may be useful to measure intervention impact.
12 - Gastrointestinal System
- from Systemic Psychophysiology
- Edited by John T. Cacioppo, University of Chicago, Louis G. Tassinary, Texas A & M University, Gary G. Berntson, Ohio State University
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- Handbook of Psychophysiology
- Published online:
- 27 January 2017
- Print publication:
- 15 December 2016, pp 258-283
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Introduction to the Second Edition
- Arjen Boin, Universiteit Leiden, Paul ‘t Hart, Universiteit Utrecht, The Netherlands, Eric Stern, Bengt Sundelius
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- The Politics of Crisis Management
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- 15 December 2016
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- 21 November 2016, pp 1-2
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Summary
The original edition of this book was published in late 2005. Ten years on, the salience of its topic is undiminished. In the past decade, the world has seen many natural catastrophes, industrial accidents, high-profile acts of terrorism, crowd tragedies, cyber scares, infrastructure breakdowns, mass shootings, migration flows, and humanitarian emergencies. There is a growing awareness that in an increasingly interconnected world, crises do not stop at borders and can span entire regions or even assume a global scale.
Public expectations of governments and their leaders in times of crisis remain high. Public leaders are expected to be prepared for a wide variety of contingencies; they must “ramp up” their performance when a crisis emerges. At the same time, it is becoming increasingly clear that the tasks of crisis leadership require more than organizing an effective response. Leaders must build and support transboundary collaboration and transnational institutions that can effectively deal with the borderless nature of contemporary crises.
Much has happened over the past decade in the world of crisis management. It is fair to say that crisis management has become a profession, an industry, and a growing community of practice and research. In many governments and corporations, there are now more dedicated roles, high-level bodies, training and exercise programs, conferences, and high-tech command and communication facilities than there were a decade ago. A cross-disciplinary array of researchers, consultants, software developers, and manufacturers push the trends toward professionalization, propelled by ever-growing demand from both the corporate and the public sectors. This is perhaps what one might expect in the risk societies that the advanced nations have become. Citizens, markets, media, and politicians expect that risk is minimized, threats are mitigated, and crises are effectively combated. Leaders who fail to take this seriously will lose credibility, support or even their job when caught by a crisis.
The response to the first edition of the book neatly dovetails this trend. It has struck a chord, both with students and practitioners. As authors of the book, we were fortunate enough to receive invitations to speak to, train, exercise, and evaluate crisis managers from a wide range of countries and sectors. Even today, the book continues to be widely used in courses worldwide and in several languages. The feedback we have received during the many encounters with practitioners, students, and colleagues has been inspiring.
4 - Meaning Making: Constructing a Crisis Narrative
- Arjen Boin, Universiteit Leiden, Paul ‘t Hart, Universiteit Utrecht, The Netherlands, Eric Stern, Bengt Sundelius
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- The Politics of Crisis Management
- Published online:
- 15 December 2016
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- 21 November 2016, pp 78-101
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Summary
The Politics of Crisis Communication
Swedish Minister of Foreign Affairs Laila Freivalds paid a high political price for her visit to the theater on the evening on December 26, 2004. The Asian tsunami disaster had killed hundreds of Swedes that very day. Her visit signaled an emotional dissociation from the fate of the 30,000 vacationing Swedes in the affected region. When the prime minister of the day, long-serving Goran Persson, backed her in blaming the government's tardy response on errors committed down the foreign service hierarchy, this did not play well. In early 2005 Persson faced hostile questioning from a parliamentary inquiry, which was broadcast around the nation. A highly critical report was issued, and the tsunami crisis dogged the government all the way until the next election, which it lost.
The charismatic and popular Australian police commissioner Christine Nixon saw her career cut short as a result of her perceived lack of involvement and empathy in times of crisis. During a public inquiry following the deadly “Black Saturday” bushfires on the outskirts of greater Melbourne in February 2009, it transpired that she and her husband had gone out for a pub meal with friends while communities were burning and people were dying. The public never forgave her. Nixon initially defended herself on the basis of fact: she had delegated command responsibilities for the bushfire response to a highly experienced assistant commissioner well before the situation became critical, and she had in fact been at the command center during most of the day before going off duty. It was to no avail. The tabloid press was merciless. Expert support for her conduct at the inquiry was not enough to undo the damage. She resigned in July 2010.
In a crisis, authorities can easily lose control, if only temporarily, over the dramaturgy of political communication. Overtaken by events, they struggle to formulate a message that offers an authoritative definition of the situation, provides hope, shows empathy for victims, and gives assurances that the authorities are doing their best to minimize the consequences of the threat. Leaders do not have much time to come up with such an authoritative take on events. Politicians, citizens, and other opinion makers, all making use of (social) media venues, offer competing interpretations and powerful images crafted for mass consumption.
The Politics of Crisis Management
- Public Leadership under Pressure
- 2nd edition
- Arjen Boin, Paul ‘t Hart, Eric Stern, Bengt Sundelius
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- Published online:
- 15 December 2016
- Print publication:
- 21 November 2016
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Crisis management has become a defining feature of contemporary governance. In times of crisis, communities and members of organizations expect their leaders to minimize the impact, while critics and bureaucratic competitors make use of social media to blame incumbent rulers and their policies. In this extreme environment, policymakers must somehow establish a sense of normality, and foster collective learning from the crisis experience. In the new edition of this uniquely comprehensive analysis, the authors examine how strategic leaders deal with the challenges they face, the political risks and opportunities they encounter, the pitfalls they must avoid, and the paths towards reform they may pursue. The book is grounded in decades of collaborative, cross-national and multidisciplinary case study research and has been updated to include new insights and examples from the last decade. This is an original and important contribution from experts in public policy and international security.
References
- Arjen Boin, Universiteit Leiden, Paul ‘t Hart, Universiteit Utrecht, The Netherlands, Eric Stern, Bengt Sundelius
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- The Politics of Crisis Management
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- 15 December 2016
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- 21 November 2016, pp 172-197
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Index
- Arjen Boin, Universiteit Leiden, Paul ‘t Hart, Universiteit Utrecht, The Netherlands, Eric Stern, Bengt Sundelius
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- The Politics of Crisis Management
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- 15 December 2016
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- 21 November 2016, pp 198-200
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6 - Learning and Changing: From Crisis to Reform
- Arjen Boin, Universiteit Leiden, Paul ‘t Hart, Universiteit Utrecht, The Netherlands, Eric Stern, Bengt Sundelius
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- The Politics of Crisis Management
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- 15 December 2016
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- 21 November 2016, pp 126-144
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Summary
Never Again!
Conventional wisdom suggests that human progress requires that we learn from our failures. As crises unearth failing policies, procedures, and organizations, they provide clear-cut opportunities to learn and adapt. We would therefore expect policy makers to study what went wrong before and during a crisis and to change ideas, policies, structures, and processes in accordance with their findings.
In a context of competing accounts of what happened it is, however, not so easy to determine what went wrong and what should be adapted to prevent similar crises from happening again. Many different and sometimes contradictory lessons can be distilled from one and the same crisis experience. Moreover, stakeholders often disagree on what the right lessons are. As we have seen in Chapter 5, the post-crisis period is not necessarily one of social unity, mindful inquiry, and dispassionate reflection. The adversarial politics of the aftermath will affect the identification and selection of the lessons to be learned from crisis. Even when there is agreement on certain measures to be taken, there is no guarantee that lessons learned will actually be implemented. And consensus about lessons does not necessarily mean that the lessons will be sufficient to prevent similar mistakes from happening in the future.
Consider the rash of new policies, legal changes, and major institutional reforms and reorganizations that were pushed through the legislature at unprecedented speed after the 9/11 events – in the United States, the European Union, and many other countries. In the U.S., the so-called Patriot Act was adopted in near unanimity, enacting policy changes in the judicial system, in the handling of immigrants and resident aliens, and in the allocation of government funds for national security and public safety. In a major administrative reorganization effort, many security-related and emergency management agencies were merged at the stroke of a pen into the vast Department of Homeland Security. The department, with its 170,000 employees and wide responsibilities for dealing with different contingencies, could not prevent – and some would say contributed to – a botched response to Hurricane Katrina (summer of 2005).
The European Union learned and changed in much more incremental fashion. A uniform definition of terrorism was accepted; extradition rules for potentially terrorism-related crimes were extended. Police units can now track suspected criminals across national borders and, if necessary, act with full authority on foreign soil.
7 - How to Deal with Crisis: Lessons for Prudent Leadership
- Arjen Boin, Universiteit Leiden, Paul ‘t Hart, Universiteit Utrecht, The Netherlands, Eric Stern, Bengt Sundelius
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- The Politics of Crisis Management
- Published online:
- 15 December 2016
- Print publication:
- 21 November 2016, pp 145-171
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Summary
Navigating Crises
In this book, we have presented a number of claims about leadership in times of crisis. These are based on the findings of several decades of crisis research, direct observation of crisis managers in action (in real-world settings and simulated contexts), and ongoing dialogue with experienced and reflective practitioners. In this final chapter, we translate key observations from the evolving body of crisis management research into recommendations for improving crisis management practices.
Navigating crises prudently is a complex leadership challenge. Trade-offs must be made among various key values and constraints. Policy makers must make decisions and live with the consequences of their actions or inactions. Citizens either suffer the effects of governmental unpreparedness or reap the benefits secured by well-prepared leaders and resilient institutions. Effective crisis navigation requires leaders to prepare themselves and their organizations to deal with this challenge well ahead of the moment when they find themselves in the “hot seat” of crisis. Our recommendations do not tell policy makers what to do but offer ideas and suggestions about how prudent crisis leadership might be facilitated, organized, and exercised.
Grasping the Nature of Crises
Let us begin with the nature of the beast. What is it that makes crises so difficult to handle? And what should policy makers understand about crises when they seek to enhance their crisis leadership capacities?
One of the most important things to keep in mind is that crisis is a label, a semantic construction people use to characterize situations that they somehow regard as extraordinary, volatile, and potentially far-reaching in their negative implications. Why people collectively label and experience a situation as a crisis remains something of a mystery. Physical facts, numbers, and other seemingly objective indicators are important factors, but they are not decisive. A flood that kills 200 people is a more or less routine emergency in Bangladesh, but it would be experienced as a major crisis in, let's say, New Jersey or Poland. Similarly, seasonal influenza kills somewhere between three thousand and fifty thousand persons per year in the U.S., a fact easily obscured in the media and public consciousness by the threat posed by a relatively small number of vividly portrayed imported Ebola cases.
List of Figures
- Arjen Boin, Universiteit Leiden, Paul ‘t Hart, Universiteit Utrecht, The Netherlands, Eric Stern, Bengt Sundelius
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- Book:
- The Politics of Crisis Management
- Published online:
- 15 December 2016
- Print publication:
- 21 November 2016, pp vii-vii
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5 - Ending a Crisis: Managing Accountability
- Arjen Boin, Universiteit Leiden, Paul ‘t Hart, Universiteit Utrecht, The Netherlands, Eric Stern, Bengt Sundelius
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- The Politics of Crisis Management
- Published online:
- 15 December 2016
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- 21 November 2016, pp 102-125
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Summary
It Ain't Over Till It's Over
In July 1995, Bosnian-Serb forces occupied the town of Srebrenica, a UN safe haven in the Yugoslavian civil war, after a long siege and a brief military campaign. The Dutch military contingent (Dutchbat), the UN protector of the Muslim enclave, surrendered and was allowed a safe retreat. On return, their families, the prime minister, and the Crown Prince welcomed the Dutch troops as national heroes. For the minister of defense, who had spent several days and nights in the government bunker in The Hague from where the Dutch military commanded the besieged troops, the crisis was finally over – or so he thought.
After taking over the enclave, the Bosnian-Serbian troops commanded by Ratko Mladic killed thousands of captives who had been under Dutch protection. The world soon learned that 7,000 men had been murdered, many of them while the Dutch battalion was anxiously awaiting its safe passage home. When the atrocities came to the fore, Dutch sentiment changed quickly. Media reports asserted that the Dutch soldiers had done very little to defend the enclave. Rumors began to circulate to the effect that the Dutch had condoned and even cooperated with the Serbs, thus facilitating the ethnic cleansing.
The Dutch minister of defense, Joris Voorhoeve, would spend the remainder of his political career defending the decision to surrender the enclave. Various investigations were conducted, yet doubts lingered on in the public mind. Finally, under pressure, the prime minister decided to appoint an official inquiry by the National Institute of War Studies. When it reported in the spring of 2002, just before scheduled elections, the report cleared the army of the cowardice charges but roundly criticized the government's decision to send Dutch troops into such a hazardous and badly supported UN mission. The government resigned. Seven years after Srebrenica, the political crisis was finally over.
The civil and criminal court battles continued, however. The “mothers of Srebrenica” proved unrelenting in their efforts to seek justice. Dutch and European courts knocked back their claims, but a Dutch court ruled in 2013 that the Dutchbat squadron did bear legal (though not criminal) liability for the deportations and subsequent killing of Bosnian Muslim men. The Srebrenica tragedy had become a wound that kept bleeding.
Frontmatter
- Arjen Boin, Universiteit Leiden, Paul ‘t Hart, Universiteit Utrecht, The Netherlands, Eric Stern, Bengt Sundelius
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- Book:
- The Politics of Crisis Management
- Published online:
- 15 December 2016
- Print publication:
- 21 November 2016, pp i-iv
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Contents
- Arjen Boin, Universiteit Leiden, Paul ‘t Hart, Universiteit Utrecht, The Netherlands, Eric Stern, Bengt Sundelius
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- Book:
- The Politics of Crisis Management
- Published online:
- 15 December 2016
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- 21 November 2016, pp v-vi
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2 - Sense Making: Grasping Crises as They Unfold
- Arjen Boin, Universiteit Leiden, Paul ‘t Hart, Universiteit Utrecht, The Netherlands, Eric Stern, Bengt Sundelius
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- Book:
- The Politics of Crisis Management
- Published online:
- 15 December 2016
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- 21 November 2016, pp 23-48
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Summary
What the Hell Is Going On?
On the morning of September 11, 2001, U.S. President George W. Bush was listening to a group of children reading at a Sarasota, FL elementary school when he learned about the second plane crashing into the World Trade Center. He stayed in the classroom for several minutes, ostensibly listening to the reading. But the cameras captured the look of shock on his face as the president tried to make sense of the news that the country had come under attack.
The 9/11 terrorist strike took Bush, his country, and the rest of the world by complete surprise. As the drama unfolded live on television screens across the globe, people found themselves watching in disbelief: “This cannot be happening.” This sense of collective stress soon gave rise to pressing questions: how could this have happened and why did the authorities not see it coming?
Making sense of an unfolding crisis – from its roots to its “hot” phase and its aftermath – is a core challenge of crisis management. If intelligence agencies recognize an emerging threat early on, they can try to prevent it from materializing. If crisis managers quickly and fully understand the causes, characteristics, and consequences of an unfolding crisis, they are more likely to mitigate its impact. The sense-making task thus has two components: detection (of emerging threats and vulnerabilities) and understanding (of an unfolding crisis). In this chapter – and this is our key question – we ask what factors affect the effectiveness of sense making before and during crisises.
Detecting an impending threat before it escalates into a full-blown crisis can be extremely hard. Whether it is a prison riot or a terrorist act, a natural disaster, an international conflict, an environmental contingency, or an economic crisis – authorities rarely see them coming. Yet, hindsight knowledge always seems to reveal that there were strong indications of growing risks or outright warnings that somehow went unnoticed or failed to prompt remedial action. This is not because of some inherent incompetence of policymakers and organizations. In this chapter – and this is our first core claim – we argue that many types of impending crises are very difficult to recognize in advance.
1 - Managing Crises: Five Strategic Leadership Tasks
- Arjen Boin, Universiteit Leiden, Paul ‘t Hart, Universiteit Utrecht, The Netherlands, Eric Stern, Bengt Sundelius
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- Book:
- The Politics of Crisis Management
- Published online:
- 15 December 2016
- Print publication:
- 21 November 2016, pp 3-22
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Summary
Crisis Management and Public Leadership
Governance has increasingly become a matter of crisis management. Crises routinely shatter the peace and order of societies. They arrive as “rude surprises” and “inconvenient truths” wreaking havoc and destroying the legitimacy of public institutions. Natural disasters, the collapse of financial systems, high-tech catastrophes, lone-wolf terrorists, mass revolts, new pandemics, geopolitical powder kegs, and cyber attacks – the list of potential crises is long and growing.
Disruptions of the dominant order are as old as life itself. The Bible can be read as a catalog of the frightening crises that have beset humankind since time immemorial. Most of the world still confronts these “old” crises on a regular basis. But we also see new crises – and new twists on more familiar ones – that define the times we live in: Lehman Brothers and the Euro crisis, Arab Spring and failed states, Fukushima and Deepwater Horizon, Mumbai and Paris, Ebola and ISIS.
In such times of crisis, citizens look to their leaders. The system is out of kilter, and leaders are expected to chart pathways out of the crisis. The public expects them to avert the threat or at least minimize the damage of the crisis at hand. They must explain what went wrong. They must adapt, change or abandon routine ways of operating where needed and create public confidence in the new status quo. They should work toward enhancing community resilience, preparing society for future shocks.
Crises provide real-world “stress tests” to the resilience of political systems and the crisis management capacities of leaders. They play out against a backdrop of public expectations (influenced in part by leaders themselves) that can be very challenging to meet. In some cases, the quality of crisis management makes the difference between life and death, chaos and order, breakdown and resilience. When governments and their leaders respond well to a crisis, the damage is limited. When emerging vulnerabilities and threats are adequately assessed and addressed, some potentially devastating contingencies simply do not happen. When crisis management fails, the impact increases.
Crisis management bears directly on the lives of citizens and the well-being of societies. The notion of “crisis management” as used in this book is shorthand for a set of interrelated and extraordinary governance challenges.