This article presents a method developed to assess laser Directed Energy Weapon engagements. This method applies physics-based models, which have been validated by experiments. It is used to assess the capabilities of the Airborne Laser (ABL), a system for boost phase missile defense purposes, which is in development under supervision of the U.S. missile defense agency. Implications for international security are presented.

The article begins with a general introduction to laser Directed Energy Weapons (DEW). It is notable that several laser directed energy weapon prototypes have recently become operational for testing. One of them is the ABL, a megawatt-class laser installed into a cargo aircraft. It is concluded that only the ABL could have significant political impact on an international scale at the moment. Hence, the remainder of the article focuses on the assessment of that system. The laser intensity, the induced temperature increase of a target and the impact of this temperature increase on the mechanical properties of the target are calculated for different scenarios. It is shown that the defensive capability of the ABL against ballistic missiles is limited. Even a successful laser engagement that deflects a missile trajectory from its intended target can have negative impact for third parties, as missile warheads will most likely not be destroyed.

A collection of core faculty Victor Fuchs' articles on actions needed for meaningful health care reform in the United States.

• Eliminating "Waste" in Health Care
• Four Health Care Reforms for 2009
• Cost Shifting Does Not Reduce the Cost of Health Care.
• The Proposed Government Health Insurance Company - No Substitute for Real Reform
• Reforming US Health Care - Key Considerations for the New Administration.
• Health Reform: Getting The Essentials Right
• Health Care Reform - Why So Much Talk and So Little Action?
• Three "Inconvenient Truths" about Health Care
• The Perfect Storm of Overutilization
• Who Really Pays for Health Care? The Myth of "Shared Responsibility".
• What Are The Prospects For Enduring Comprehensive Health Care Reform?
• Essential Elements of a Technology and Outcomes Assessment Initiative

Abstract

The Technological Change in Health Care Research Network collected unique patient-level data on three procedures for treatment of heart attack patients (catheterization, coronary artery bypass grafts and percutaneous transluminal coronary angioplasty) for 17 countries over a 15-year period to examine the impact of economic and institutional factors on technology adoption. Specific institutional factors are shown to be important to the uptake of these technologies. Health-care systems characterized as public contract systems and reimbursement systems have higher adoption rates than public-integrated health-care systems. Central control of funding of investments is negatively associated with adoption rates and the impact is of the same magnitude as the overall health-care system classification. GDP per capita also has a strong role in initial adoption. The impact of income and institutional characteristics on the utilization rates of the three procedures diminishes over time.

The world of genomics is transforming medicine, and is likely to influence the future development of new drugs, diagnostics, and vaccines. To date, the greater focus of genomics and medicine has been on conditions affecting resourcewealthy settings, primarily involving scientists and companies in those settings. However, we believe that it is possible to expand genomics into a more global technology that can also focus on diseases of resource-limited settings. This goal can be achieved if genomics is made a global priority. We feel one way to move in this direction is through a comprehensive approach to infectious diseases-i.e., an Infectious Disease Genomics Project-that would mirror the Human Genome Project. Without an active, unified effort specifically focused on allowing actors at any level to participate in the genomics revolution, infectious diseases that primarily affect the poor will likely not achieve the same level of scientifici advancement as diseases affecting the wealthy.

Executive Summary of Report

Nearly twenty years after the end of the Cold War, Russia and the United States continue to maintain hundreds of nuclear weapons capable of striking the other side, and to have at least some of these nuclear forces at Cold War levels of alert, that is, ready to fire within a few minutes of receiving an order to do so.

Even during the Cold War, alert levels were not static and moved up or down in step with changes in the strategic and tactical environments. While the operational readiness of some weapon systems has been reduced, there has been no major change in the readiness levels of most of the nuclear weapon systems in the post-Cold War era. This is in considerable part because Russia and the United States believe that despite fundamental changes in their overall relationship, vital interest requires maintaining a high level of nuclear deterrence.

The post-Cold War experience also demonstrates that alert levels can be reduced and measures can be taken to reduce the risk of accidents or unauthorized takeover of nuclear weapons. Further measures could be taken to reduce operational readiness of nuclear arsenals. U.S. and Russian experts alike stressed survivability as a key element in the acceptance of these measures because of its importance to maintaining deterrence.

Cold War legacy postures under which thousands of weapons are kept on high readiness can be altered through top-down policy initiatives, as was the case in the early 1990s with one class of nuclear weapons.

Technical issues related to the peculiar "ready" character of land-based ICBMs can be resolved by bringing designers into discussions on decreasing operational readiness of nuclear weapons. There was a sense that technical solutions to the problems of nuclear risk reduction are available and can be multilateralized. Information sharing can help implementation of these solutions.

Concerns over "re-alerting" races and vulnerability of "de-alerted" forces to conventional or nuclear strikes during "reversal" can be addressed through survivable forces, dialogue, and confidence building.

Other nuclear weapon states apparently have alert practices that differ from those of Russia and the United States. It was debated whether this state of affairs can be ascribed to an absence of nuclear war fighting capabilities or to a different assessment of the post-Cold War nuclear security environment. There was a sense that nuclear doctrines and alert practices of different nuclear weapon states cannot be analyzed in a vacuum and must be evaluated as parts of a larger political and security framework.

Non-nuclear weapon states' experts forcefully asserted the legitimate interest their states have in the issue and underlined the practical and constructive approach of the U.N. General Assembly resolution on reducing operational readiness of nuclear forces.

Non-nuclear weapon states say that lowering of the operational status of nuclear weapons would both reduce the risk of accidental or unintended nuclear war and provide a much-needed practical boost for disarmament and nonproliferation. Decreasing the operational readiness of nuclear weapons would be a highly desirable confidence-building measure between nuclear weapon states and non-nuclear weapon states. It would also be a welcome step in the lead-up to the 2010 Non-Proliferation Treaty (NPT) Review Conference.

The principal objection to decreasing operational readiness of nuclear weapons as commonly understood has been that it seeks to address a problem that does not exist. Even if it does exist in some instances, it can be addressed by technical and organizational means updated to cover current threats such as nuclear terrorism. Furthermore, the remedy itself could end up undermining nuclear deterrence and strategic or crisis stability.

The insight that emerged during the meeting was that the above objection flows from a narrow view of de-alerting as meaning measures that make it physically impossible to promptly launch an attack on order. Such a view also leads to a somewhat excessive focus on verification of technical measures, which ends up giving an easy argument to the opponents of de-alerting-that it is not verifiable and therefore should not be attempted.

There are no fundamental obstacles to many useful measures of decreasing operational readiness of nuclear weapons, provided the issue is not framed narrowly. De-alert has to be seen not only as a technical fix but also as a strategic step in deemphasizing the military role of nuclear weapons, in other words, moving to retaliatory strike postures and doctrines instead of legacy preemptive or "launch on warning" postures. The ongoing U.S. Nuclear Posture Review (NPR) offers an opportunity for such a perceptual shift.

If decreasing operational readiness of nuclear weapons is reframed in this manner, several concrete steps become possible:

As part of the START follow-on negotiations, Russia and the United States could examine how measures to reduce operational readiness can accompany the bilateral arms control process.

Both Russia and the United States could further strengthen controls against unauthorized action, takeover, and tampering; further increase the capability of warning systems to discriminate real from imagined attacks; and enhance the survivability of their forces and their command and control systems.

Arrangements related to data exchange and ensuring a capability to destroy a "rogue" missile in flight could be multilateralized, at least in terms of sharing data, to bring other declared nuclear weapon states into the process.

Multilateralization of institutions such as the Joint Data Exchange Center may also have collateral benefits in the area of space security.

The premise of maintaining nuclear deterrence between Russia and the United States should not be considered immutable. A dialogue on legacy nuclear postures and doctrines in the Russia-U.S. context may trigger a broader dialogue among relevant states on reducing the salience of nuclear weapons, thus facilitating progress on disarmament and nonproliferation.

We examine the role that buyers in global supply chains play in helping vendors uncover productivity-enhancing labor management innovations. We report on a buyer-directed NGO-coordinated factory-based program targeting intestinal parasites and anemia in seven Bangalore apparel factories. Raw pre-post productivity comparisons were confounded by factory organizational changes that were implemented in anticipation of the termination of the Multi Fiber Arrangement (MFA). Using a difference-in-difference-in-difference (DDD) estimator, a full complement of medically appropriate treatment was found to increase individual productivity.

This paper develops a mathematical/economic framework to address the following question: Given a particular population, a specific HIV prevention program and a fixed amount of funds that could be invested in the program, how much money should be invested?