Class of 2011 Abstract / OBJECTIVES: The overall purpose of this study was to describe comorbidities, charges, and mortality associated with inpatient, adult traumatic brain injury (TBI) cases in the United States (US) for the year 2007. METHODS: This was a retrospective cohort analysis of discharge records located in the National Emergency Department Sample (NEDS) of the Healthcare Cost and Utilization Project (HCUP). Descriptive statistics are provided for comorbidities, charges, and mortality. Logistic regression was performed to find characteristics associated with mortality while multiple regression was used to assess charges. Independent variables included age, injury severity, procedures used, location of TBI, and primary payer. RESULTS: A total of 639,698 TBI cases were found which were associated with 267,061 hospital admissions, over $17 billion in hospital charges, and 20,620 deaths in the year 2007.Most common comorbidities were essential hypertension, sprains and strains of the back, tobacco use, fluid and electrolyte disorders, and alcohol-related disorders. Characteristics associated with increased mortality and charges included New Injury Severity Score (NISS) over 10, involvement of a firearm, falls, motor vehicle traffic, and intubation. CONCLUSION: The current study gives the most current picture of inpatient adult TBI cases throughout the US. Future research is warranted to ensure that optimal outcomes are being attained in this vulnerable patient population.

The effective oversight and management of national emergencies are critical to preserving democratic processes and norms. Congress passed the National Emergencies Act (NEA) of 1976 to regulate the open-ended and unchecked implementation of emergency authorities by the president. Notwithstanding the NEA's objectives, the number and duration of national emergencies are proliferating. National emergencies evoke a sense of urgency that results in exceptional governance procedures and alters official and public perceptions. However, national emergencies declared under the NEA rarely reflect the definition of urgency and endure for years, indicating potential oversight failures and a re-emergence of the president's unchecked use of emergency power. Concerns arise that a national emergency shifts legislative power to the executive, making government policy less democratic. The national scope of these emergencies also portends the potential for harm to a broad population. Ambiguous judicial and legislative instructions, presidential aspirations of demonstrating leadership, and congressional blame avoidance further complicate the governance of national emergencies. This research conceptualizes time as the intelligible principle that Congress used to meet the judicial requirements for delegating functional responsibilities to the executive branch while retaining constitutional obligations and maintaining oversight of executive action. Sequences, deadlines, and repetition are temporal mechanisms that help regulate government action and moderate authorities. Understanding how temporal policy mechanisms affect the use of emergency authority, shape government interaction, and adjust accountability is particularly important as the United States confronts a hyper-partisan environment and demands to confront new issues as national emergencies intensify. Employing a policy tracing methodology augmented by survival and qualitative comparative analysis, this dissertation analyzes national emergency data composed of declarations, continuations, amendments, and terminations. The analysis incorporates Supreme Court decisions, budgetary impact statements, and Federal Register data to track and evaluate national emergencies declared via presidential proclamation and executive order. The ensuing model delineates the properties of the national emergencies declared under the NEA and clarifies relational factors contributing to temporal variation amongst emergency declarations. The resulting clarity contributes to scholarly and governmental use of temporal policy mechanisms—particularly sequences, deadlines, and repetition—and offers recommendations for enhancing the oversight of U.S. national emergencies. / Doctor of Philosophy / The oversight and management of national emergencies are crucial for protecting democratic processes and norms. In 1976, Congress passed the National Emergencies Act (NEA) to prevent the president from using unconstrained emergency powers. However, the NEA has not been successful in controlling the frequency and duration of national emergencies. During a national emergency, a sense of urgency generally leads to exceptional governance procedures and changes how people perceive governance situations. This research examined national emergency declarations, continuations, amendments, and terminations to understand how the NEA governs emergencies and what principles guide it. The findings show that national emergencies declared under the NEA have limited congressional oversight and are increasingly influenced by politics. The lack of clear instructions from the judiciary and the legislature, the president's desire to display leadership, and Congress' tendency to avoid blame further complicate the governance of national emergencies, allowing them to last for many years without proper oversight. To address the weaknesses in the NEA and improve the handling of national emergencies, this dissertation proposes the concept of temporal policy mechanisms. Temporal policy mechanisms use time as a guiding principle to delegate emergency authority and ensure accountability. Examples of temporal mechanisms include sequences, deadlines, and repetition to regulate government actions and moderate authorities. The analysis also highlights origination bias, where Congress sets rules for others but fails to follow its own processes. By implementing transparent temporal policy mechanisms and reducing the sense of urgency during prolonged national emergencies, accountability and transparency can be enhanced thereby upholding U.S. constitutional principles and benefiting they citizenry.