About

Arthur Isak Applbaum is the Adams Professor of Political Leadership and Democratic Values at Harvard Kennedy School, where he also serves as chair of the Democracy, Politics, and Institutions area. His work focuses on political legitimacy, civil and official disobedience, and role morality. He is the author of the books "Legitimacy: The Right to Rule in a Wanton World" published by Harvard University Press, and "Ethics for Adversaries: The Morality of Roles in Public and Professional Life" published by Princeton University Press. Applbaum has contributed to academic journals such as Philosophy & Public Affairs, Journal of the American Medical Association, Harvard Law Review, Ethics, and Legal Theory, exploring topics including the ethics of executioners and butlers, and has consulted with the government on the ethics of spies. He has held leadership roles including Acting Director of the Edmond J. Safra Center for Ethics at Harvard, where he currently directs the undergraduate fellowships in ethics. His teaching includes establishing the core course in political ethics at the Kennedy School and instructing the core course in political philosophy for international development students. Applbaum holds degrees from Princeton and Harvard, and has been a Fulbright Scholar in Jerusalem, a Faculty Fellow in Ethics at Harvard, and a Rockefeller Fellow at Princeton University’s Center for Human Values.

Research topics

• Medicine
• Internal medicine
• Emergency medicine
• Surgery
• Cardiology
• Computer Science
• Radiology
• Intensive care medicine
• Medical emergency
• World Wide Web
• Pediatrics

Selected publications

• Endovascular Thrombectomy for Large Ischemic Stroke Across Ischemic Injury and Penumbra Profiles

  JAMA · 2024 · 93 citations

  • Medicine
  • Internal medicine
  • Cardiology

  Importance: Whether endovascular thrombectomy (EVT) efficacy for patients with acute ischemic stroke and large cores varies depending on the extent of ischemic injury is uncertain. Objective: To describe the relationship between imaging estimates of irreversibly injured brain (core) and at-risk regions (mismatch) and clinical outcomes and EVT treatment effect. Design, Setting, and Participants: An exploratory analysis of the SELECT2 trial, which randomized 352 adults (18-85 years) with acute ischemic stroke due to occlusion of the internal carotid or middle cerebral artery (M1 segment) and large ischemic core to EVT vs medical management (MM), across 31 global centers between October 2019 and September 2022. Intervention: EVT vs MM. Main Outcomes and Measures: Primary outcome was functional outcome-90-day mRS score (0, no symptoms, to 6, death) assessed by adjusted generalized OR (aGenOR; values >1 represent more favorable outcomes). Benefit of EVT vs MM was assessed across levels of ischemic injury defined by noncontrast CT using ASPECTS score and by the volume of brain with severely reduced blood flow on CT perfusion or restricted diffusion on MRI. Results: Among 352 patients randomized, 336 were analyzed (median age, 67 years; 139 [41.4%] female); of these, 168 (50%) were randomized to EVT, and 2 additional crossover MM patients received EVT. In an ordinal analysis of mRS at 90 days, EVT improved functional outcomes compared with MM within ASPECTS categories of 3 (aGenOR, 1.71 [95% CI, 1.04-2.81]), 4 (aGenOR, 2.01 [95% CI, 1.19-3.40]), and 5 (aGenOR, 1.85 [95% CI, 1.22-2.79]). Across strata for CT perfusion/MRI ischemic core volumes, aGenOR for EVT vs MM was 1.63 (95% CI, 1.23-2.16) for volumes ≥70 mL, 1.41 (95% CI, 0.99-2.02) for ≥100 mL, and 1.47 (95% CI, 0.84-2.56) for ≥150 mL. In the EVT group, outcomes worsened as ASPECTS decreased (aGenOR, 0.91 [95% CI, 0.82-1.00] per 1-point decrease) and as CT perfusion/MRI ischemic core volume increased (aGenOR, 0.92 [95% CI, 0.89-0.95] per 10-mL increase). No heterogeneity of EVT treatment effect was observed with or without mismatch, although few patients without mismatch were enrolled. Conclusion and Relevance: In this exploratory analysis of a randomized clinical trial of patients with extensive ischemic stroke, EVT improved clinical outcomes across a wide spectrum of infarct volumes, although enrollment of patients with minimal penumbra volume was low. In EVT-treated patients, clinical outcomes worsened as presenting ischemic injury estimates increased. Trial Registration: ClinicalTrials.gov Identifier: NCT03876457.

  PublisherOA PDFDOI

• Empagliflozin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

  The Lancet Diabetes & Endocrinology · 2023 · 38 citations

  • Medicine
  • Emergency medicine
  • Internal medicine

  BACKGROUND: Empagliflozin has been proposed as a treatment for COVID-19 on the basis of its anti-inflammatory, metabolic, and haemodynamic effects. The RECOVERY trial aimed to assess its safety and efficacy in patients admitted to hospital with COVID-19. METHODS: In the randomised, controlled, open-label RECOVERY trial, several possible treatments are compared with usual care in patients hospitalised with COVID-19. In this analysis, we assess eligible and consenting adults who were randomly allocated in a 1:1 ratio to either usual standard of care alone or usual standard of care plus oral empagliflozin 10 mg once daily for 28 days or until discharge (whichever came first) using web-based simple (unstratified) randomisation with allocation concealment. The primary outcome was 28-day mortality; secondary outcomes were duration of hospitalisation and (among participants not on invasive mechanical ventilation at baseline) the composite of invasive mechanical ventilation or death. On March 3, 2023 the independent data monitoring committee recommended that the investigators review the data and recruitment was consequently stopped on March 7, 2023. The ongoing RECOVERY trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). FINDINGS: Between July 28, 2021 and March 6, 2023, 4271 patients were randomly allocated to receive either empagliflozin (2113 patients) or usual care alone (2158 patients). Primary and secondary outcome data were known for greater than 99% of randomly assigned patients. Overall, 289 (14%) of 2113 patients allocated to empagliflozin and 307 (14%) of 2158 patients allocated to usual care died within 28 days (rate ratio 0·96 [95% CI 0·82-1·13]; p=0·64). There was no evidence of significant differences in duration of hospitalisation (median 8 days for both groups) or the proportion of patients discharged from hospital alive within 28 days (1678 [79%] in the empagliflozin group vs 1677 [78%] in the usual care group; rate ratio 1·03 [95% CI 0·96-1·10]; p=0·44). Among those not on invasive mechanical ventilation at baseline, there was no evidence of a significant difference in the proportion meeting the composite endpoint of invasive mechanical ventilation or death (338 [16%] of 2084 vs 371 [17%] of 2143; risk ratio 0·95 [95% CI 0·84-1·08]; p=0·44). Two serious adverse events believed to be related to empagliflozin were reported: both were ketosis without acidosis. INTERPRETATION: In adults hospitalised with COVID-19, empagliflozin was not associated with reductions in 28-day mortality, duration of hospital stay, or risk of progressing to invasive mechanical ventilation or death so is not indicated for the treatment of such patients unless there is an established indication due to a different condition such as diabetes. FUNDING: UK Research and Innovation (Medical Research Council) and National Institute of Health Research (MC_PC_19056), and Wellcome Trust (222406/Z/20/Z). TRANSLATIONS: For the Nepali, Hindi, Indonesian (Bahasa) and Vietnamese translations of the abstract see Supplementary Materials section.

  DOI

• Society of NeuroInterventional Surgery recommendations for the care of emergent neurointerventional patients in the setting of COVID-19

  Journal of NeuroInterventional Surgery · 2020 · 102 citations

  • Medicine
  • Emergency medicine
  • Intensive care medicine

  The global pandemic of coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), represents an unprecedented challenge to our healthcare system.1 As the number of identified COVID-19 patients exponentially increases, protocols for the safe delivery of care of both patients and providers are vital. This is especially true, given the number of healthcare providers who have contracted the disease. If we fail to protect physicians, nursing staff, and ancillary providers, we will fail to meet the needs of future patients. The successful care of future COVID-19 patients will depend on effective safety and prevention strategies for healthcare workers.\nWhile the data on COVID-19 are rapidly emerging, the Society of NeuroInterventional Surgery seeks to provide neurointerventionalists with rapid up-to-date recommendations on the management of stroke thrombectomy in this setting with an emphasis on safety measures for healthcare providers.

  DOI

• Delayed presentation of acute ischemic strokes during the COVID-19 crisis

  Journal of NeuroInterventional Surgery · 2020 · 144 citations

  • Medicine
  • Emergency medicine
  • Pediatrics

  BACKGROUND: The COVID-19 pandemic has disrupted established care paths worldwide. Patient awareness of the pandemic and executive limitations imposed on public life have changed the perception of when to seek care for acute conditions in some cases. We sought to study whether there is a delay in presentation for acute ischemic stroke patients in the first month of the pandemic in the US. METHODS: The interval between last-known-well (LKW) time and presentation of 710 consecutive patients presenting with acute ischemic strokes to 12 stroke centers across the US were extracted from a prospectively maintained quality database. We analyzed the timing and severity of the presentation in the baseline period from February to March 2019 and compared results with the timeframe of February and March 2020. RESULTS: There were 320 patients in the 2-month baseline period in 2019, there was a marked decrease in patients from February to March of 2020 (227 patients in February, and 163 patients in March). There was no difference in the severity of the presentation between groups and no difference in age between the baseline and the COVID period. The mean interval from LKW to the presentation was significantly longer in the COVID period (603±1035 min) compared with the baseline period (442±435 min, P<0.02). CONCLUSION: We present data supporting an association between public awareness and limitations imposed on public life during the COVID-19 pandemic in the US and a delay in presentation for acute ischemic stroke patients to a stroke center.

  DOI

• How to WEB: a practical review of methodology for the use of the Woven EndoBridge

  Journal of NeuroInterventional Surgery · 2020 · 166 citations

  Senior authorCorresponding
  • Computer Science
  • Medicine
  • Surgery

  Wide-necked bifurcation aneurysms (WNBAs) make up 26-36% of all brain aneurysms. Treatments for WNBAs pose unique challenges due to the need to preserve major bifurcation vessels while achieving a durable occlusion of the aneurysm. Intrasaccular flow disruption is an innovative technique for the treatment of WNBAs. The Woven EndoBridge (WEB) device is the only United States Food and Drug Administration approved intrasaccular flow disruption device. In this review article we discuss various aspects of treating WNBAs with the WEB device, including indications for use, aneurysm/device selection strategies, antiplatelet therapy requirement, procedural technique, potential complications and bailouts, and management strategies for residual/recurrent aneurysms after initial WEB treatment.

  DOI

• Predicting the degree of difficulty of the trans-radial approach in cerebral angiography

  Journal of NeuroInterventional Surgery · 2020 · 43 citations

  Senior authorCorresponding
  • Medicine
  • Radiology
  • Cardiology

  BACKGROUND: To evaluate anatomical and clinical factors that make trans-radial cerebral angiography more difficult. METHODS: A total of 52 trans-radial diagnostic angiograms were evaluated in a tertiary care stroke center from December 2019 until March 2020. We analyzed a number of anatomical variables to evaluate for correlation to outcome measures of angiography difficulty. RESULTS: The presence of a proximal radial loop had a higher conversion to femoral access (p<0.03). The presence of a large diameter aortic arch (p<0.01), double subclavian innominate curve (p<0.01), left proximal common carotid artery (CCA) loop (p<0.001), acute subclavian vertebral angle (p<0.01), and absence of bovine aortic arch anatomy (p=0.03) were associated with more difficult trans-radial cerebral angiography and increased fluoroscopy time-per-vessel. CONCLUSION: The presence of a proximal radial loop, large diameter aortic arch, double subclavian innominate curve, proximal left CCA loop, acute subclavian vertebral angle, and absence of bovine aortic arch anatomy were associated with more difficult trans-radial cerebral angiography. We also introduce a novel grading scale for diagnostic trans-radial angiography.

  DOI

Frequent coauthors

• Adnan H. Siddiqui

  University at Buffalo, State University of New York

  680 shared

• Raymond D Turner

  Siemens Healthcare (United States)

  608 shared

• Lucas Elijovich

  Semmes Murphey Foundation

  587 shared

• Peter Kan

  The University of Texas Medical Branch at Galveston

  581 shared

• Elad I. Levy

  Canon (United States)

  549 shared

• Nitin Goyal

  537 shared

• Georgios Tsivgoulis

  Université Paris Cité

  496 shared

• Andrei V. Alexandrov

  Banner Health

  470 shared

Education

• Fellowship, Interventional Neuroradiology/Cerebrovascular Neurosurgery

  University of Tennessee Health Science Center

  2006

• Master of Public Health, School of Public Health

  University of Utah

  2002

• Doctor of Medicine

  University of Virginia

  1998

• Bachelor of Arts in Biology

  University of Virginia

  1992

Awards & honors

• Fulbright Scholar in Jerusalem
• Faculty Fellow in Ethics at Harvard
• Rockefeller Fellow at Princeton University’s Center for Huma…

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