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Catharine C. Kristian
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A proposal to assess the societal and security implications of the female deficit in China, a study of the impact of higher education's rapid expansion in large developing economies, and incentives for provision of health care services for one billion people in rural China were among the new projects funded by Stanford's Presidential Fund for Innovation in International Studies (PFIIS) in mid-February. Planning grants for an international health and society initiative in the Indian subcontinent and psychosocial treatment for children orphaned by the tsunami in Indonesia were also awarded.

"These projects show great potential to advance human knowledge, help devise sustainable solutions, and build a better, more secure future for millions around the world," said Stanford President John Hennessy. "In launching The Stanford Challenge, we committed to marshal university resources to address some of the 21st century's great challenges in human health, international peace and security, and the environment."

The $3 million, intellectual venture capital fund was established by the Office of the President and the Stanford International Initiative in 2005 to encourage new cross-campus, interdisciplinary research and teaching among all seven schools at Stanford on three overarching global challenges: pursuing peace and security, improving governance, and advancing human well-being. The first $1 million was awarded in February 2006 to eight interdisciplinary faculty teams examining such issues as the HIV/AIDS treatment revolution in sub-Saharan Africa, why Latin America has been left behind in recent gains by developing countries, and food security and the environment.

"It's impressive to see the committed, collaborative, and innovative ways Stanford faculty are joining together in new interdisciplinary research and teaching to generate new understanding of the linkages among complex problems and train a new generation of leaders to address them effectively," said Freeman Spogli Institute Director Coit D. Blacker, chair of the International Initiative Executive Committee.

New projects qualifying for funding and their principal investigators are:

  • Female Deficit and Social Stability in China: Implications for International Security. Melissa Brown, anthropological sciences; Marcus Feldman, biological sciences, and Matthew Sommer, history. As the number of surplus, marriage-age men in China approaches 47 million in 2050, this project will study factors that predict men's inability to marry before 30, the availability of social welfare to men and their families, their contribution to the floating population of rural-to- urban migrants, the labor-related migration of unmarried women, and the impact of this migration for domestic stability and international security.
  • Potential Economic and Social Impacts of Rapid Higher Education Expansion in the World's Largest Developing Economies. Martin Carnoy, education; Amos Nur, geophysics; and Krishna Saraswat, electrical engineering. The development of higher education systems in Brazil, Russia, India, and China (BRIC) will have a major impact on their ability to transition to large, developed, knowledge-based economies. Is the way nation states expand and reform higher education in response to global pressures an important indicator of societal capacity to achieve sustained economic growth? This project will examine differing approaches of BRIC governments to higher-education growth and reform, and ask whether these reflect differing levels of state capacity to expand the knowledge base for economic and social development and whether differing approaches result in significant changes in formation of analytical skills in university graduates, particularly scientists and engineers.
  • Health Care for One Billion: Experimenting with Incentives for the Supply of Health Care in Rural China. Scott Atlas, radiology; Scott Rozelle, the Walter H. Shorenstein Asia-Pacific Research Center, FSI. This project examines the effects of existing health policies and institutions in rural areas of China - including rural health insurance, privatization of rural clinics, and investment in township hospitals - and introduces a new experiment to study and realign incentives to address a serious flaw in China's health care system, the practice in which doctors both prescribe and derive significant profits from drugs.

Two planning grants were also awarded, as follows:

  • Stanford International Health and Society Initiative: Proposal to Plan for an Initial Program in the Indian Subcontinent. Vinod K. Bhutani, pediatrics; Nihar Nayak, obstetrics and gynecology. This project seeks to improve unacceptably high maternal and childhood morbidity and mortality rates in the Indian subcontinent by devising innovative strategies to bridge existing social and access barriers in the micro- and macro- health environment. Includes leadership training and cooperative work on practice and policy strategies with experts from Stanford and the subcontinent.
  • Psychosocial Treatment of Children Orphaned by the Asian Tsunami in Indonesia. Hugh Solvason, psychiatry; Donald Barr, sociology. This project's goal is to develop and implement changes to reduce the sense of dislocation, anxiety, and behavioral problems among tsunami orphans at the As-Syafi`iyah Orphanage in Jakarta. By arranging the children into more cohesive groups that can operate like "families" rather than their current state of random associations typically found in orphanages, the project will create a new and ordered social system. In addition, Solvason and Barr plan to develop a system of counseling interventions for the most severely symptomatic children (supervised by Stanford Psychiatry faculty). Translated measures of depression, anxiety, and PTSD will be used to assess the success of the intervention.

The projects will produce new field research, conferences, research papers, books, symposia, and courses for Stanford students.

A third round of project awards will be made in February 2008. A formal request for proposals will be issued in the fall of 2007, with proposals due by December 14, 2007. Priority is given to teams of faculty who do not typically work together, represent multiple disciplines, and address issues that fall broadly within the three primary research areas of the International Initiative. Projects are to be based on collaborative research and teaching involving faculty from two or more disciplines, and where possible, from two or more of Stanford's seven schools.

For additional information, contact Catharine Kristian, ckristian@stanford.edu.

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This issue of CHP/PCOR's quarterly newsletter, which covers news from the summer 2006 quarter, includes articles about:

  • research by CHP/PCOR investigators that influenced the Centers for Disease Control and Prevention to recommend widespread voluntary HIV screening for all Americans ages 13 to 64 -- a significant change from the CDC's previous HIV screening guidelines;
  • a CHP/PCOR study on patient safety culture in U.S. hospitals -- the largest effort to date to measure hospitals' safety culture and seek to improve it through an intervention that gets hospital executives out of their offices and on to the hospital floors;
  • an early-stage project in which CHP/PCOR is collaborating with the Center on Democracy, Development and the Rule of Law to study the relationship between health interventions, governance and development;
  • an evidence report examining the challenges of diagnosing and treating anthrax in children, prepared by the Stanford-UCSF Evidence-based Practice Center; and
  • a study by CHP/PCOR fellow Kate Bundorf which found that depending on the definition of "affordability" that is used, health insurance is "affordable" to between one-quarter and three-quarters of the uninsured -- and many of those who can't afford insurance purchase it anyway.
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All around the world, societies are experiencing an explosion of organizations and organizing: community clubs, religious groups, social movements, as well as schools, hospitals, businesses and government agencies, increasingly take the form of complex and formal organization. Why? Why is global society recast in this format and why so fiercely?

This book explores various dimensions of the trends of expansion, formalization, and standardization of organizing worldwide by exploring such organizational legacies as accounting, business management, corporate social responsibility, and performance benchmarks. Featuring contributions from prominent academics, the book argues that these processes can be attributed to globalization and to its specific tendencies of universalism, rationalization, and rise of the modern notion of the strongly bounded and purposive social actor.

An application of institutional arguments to global issues, the book will be of interest to academics and researchers of Organization Studies, Sociology, Political Science, and Geography.

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Oxford University Press in "Globalization and Organization"
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John Meyer
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Many states have "prudent layperson" mandates that require health plans to reimburse hospitals for emergency department (ED) care delivered to patients who believe that they have symptoms warranting emergency treatment. Increased, and possibly unnecessary, ED use has often been attributed to these policies. We use data from thirty-five states to study relationships between passage of prudent layperson policies in the late 1990s and ED use among the privately insured. None of the analyses show evidence that the mandates are associated with increased use. We conclude that prudent layperson mandates are not associated with increases in ED visits among privately insured patients.

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Health Affairs
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Laurence C. Baker
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Does quality of care systematically differ among government-owned, private not-for-profit, and for-profit hospitals? A large empirical literature provides conflicting evidence. Through quantitative review of 46 studies since 1990, we find that several study features that can explain divergent results: analytic methods, disease studied, and data sources. For unprofitable care, how studies handle market competition and regional differences account for substantial variation. Policymakers should be aware that differences in results appear to arise predominantly from differences between studies' analytic methods. Moreover, conventional methods of meta-analytic synthesis should be applied with great caution given the considerable overlap among studied hospitals.

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NBER Working Paper #12241
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This issue of CHP/PCOR's quarterly newsletter, which covers news from the winter 2006 quarter, includes articles about:

  • a comprehensive review of worldwide anthrax cases from 1900 to 2005, conducted by CHP/PCOR researchers, which found that timely diagnosis and antibiotic treatment, along with pleural fluid drainage, are key to anthrax patients' survival;
  • an early-stage research project in which CHP/PCOR core faculty member Grant Miller is collaborating with an NGO in Bangladesh to study whether villagers' traditional cooking practices are contributing to life-threatening respiratory infections;
  • assertions by two CHP/PCOR health policy experts that health-savings accounts -- the cornerstone of President Bush's healthcare agenda -- won't save much money and won't address the fundamental problems of the U.S. healthcare system;
  • the Agency for Healthcare Research and Quality's release of the Pediatric Quality Indicators, developed by CHP/PCOR researchers and collaborators. This is the first set of data-analysis tools specifically designed to help hospitals monitor their quality of care for hospitalized children; and
  • a roundup of CHP/PCOR's 7th annual retreat, which featured panel discussions on improving healthcare quality, conducting health services research in developing countries, and health systems comparisons across industrialized nations.
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This issue of CHP/PCOR's quarterly newsletter, which covers news from the fall 2005 quarter, includes articles about:

  • a study concluding that the implantable cardioverter defibrillator -- one of the most expensive medical devices on the market -- is worth its high cost, in appropriate patients, because it prevents sudden cardiac deaths;
  • the evolution and broad application of the Quality Indicators, a set of practical tools developed by CHP/PCOR researchers that are used by hundreds of U.S. hospitals, medical groups, health insurers, state health agencies and business coalitions to screen for quality problems;
  • a study finding that the Internet can be a valuable tool to help patients with stigmatized illnesses (such as mental illness) find information about and seek treatment for their illness;
  • CHP/PCOR-hosted seminars on global health themes, given by Jack Chow of the World Health Organization -- who discussed combating malaria, TB and HIV/AIDS -- and Dean Jamison of the NIH's Fogarty International Center, who discussed evaluating countries' performance on health; and
  • a prestigious national award won by two CHP/PCOR trainees at the annual meeting of the Society for Medical Decision Making.
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This paper compares the relative efficiency of health care providers in managing patients with severe chronic illnesses over fixed periods of time. To minimize the contribution of differences in severity of illness to differences in care management, we evaluate performance over fixed intervals prior to death for patients who died during a five-year period, 1999-2003. Medicare spending, hospital bed and full-time equivalent (FTE) physician inputs, and utilization varied extensively between regions, among hospitals located within a given region, and among hospitals belonging to a given hospital system. The data point to important opportunities to improve efficiency.

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Health Affairs
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Laurence C. Baker
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Lynn Eden is associate director for research/senior research scholar at CISAC. Eden received her Ph.D. in sociology from the University of Michigan, held several pre- and post-doctoral fellowships, and taught in the history department at Carnegie Mellon before coming to Stanford. Her book Whole World on Fire: Organizations, Knowledge, and Nuclear Weapons Devastation won the American Sociological Association's 2004 Robert K. Merton Award for best book in science, knowledge, and technology.

Michael May is professor emeritus (research) in the Stanford University School of Engineering and a senior fellow with the Freeman Spogli Institute for Intenrational Studies. He is the former co-director of Stanford University's Center for International Security and Cooperation, and a director emeritus of the Lawrence Livermore National Laboratory, where he worked from 1952 to 1988.

Charles Perrow is professor emeritus of sociology at Yale University. His current interests are in managing highly interactive, tightly-coupled-systems (including hospitals, nuclear plants, chemical plants, power grids, aviation, the space program, and intelligent transportation systems). These interests grew out of his work on "normal accidents," with its emphasis upon organizational design and systems theory. An organizational theorist, he is the author of a number of award winning books in the field of sociology.

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Lynn Eden is a Senior Research Scholar Emeritus. She was a Senior Research Scholar at Stanford University's Center for International Security and Cooperation until January 2016, as well as was Associate Director for Research. Eden received her Ph.D. in sociology from the University of Michigan, held several pre- and post-doctoral fellowships, and taught in the history department at Carnegie Mellon before coming to Stanford.

In the area of international security, Eden has focused on U.S. foreign and military policy, arms control, the social construction of science and technology, and organizational issues regarding nuclear policy and homeland security. She co-edited, with Steven E. Miller, Nuclear Arguments: Understanding the Strategic Nuclear Arms and Arms Control Debates (Ithaca, N.Y.: Cornell University Press, 1989). She was an editor of The Oxford Companion to American Military History (New York: Oxford University Press, 2000), which takes a social and cultural perspective on war and peace in U.S. history. That volume was chosen as a Main Selection of the History Book Club.

Eden's book Whole World on Fire: Organizations, Knowledge, and Nuclear Weapons Devastation (Ithaca: Cornell University Press, 2004; New Delhi: Manas Publications, 2004) explores how and why the U.S. government--from World War II to the present--has greatly underestimated the damage caused by nuclear weapons by failing to predict damage from firestorms. It shows how well-funded and highly professional organizations, by focusing on what they do well and systematically excluding what they don't, may build a poor representation of the world--a self-reinforcing fallacy that can have serious consequences, from the sinking of the Titanic to not predicting the vulnerability of the World Trade Center to burning jet fuel. Whole World on Fire won the American Sociological Association's 2004 Robert K. Merton Award for best book in science, knowledge, and technology.

Eden has also written on life in small-town America. Her first book, Crisis in Watertown (Ann Arbor: University of Michigan Press, 1972), was her college senior thesis; it was a finalist for a National Book Award in 1973. Her second book, Witness in Philadelphia, with Florence Mars (Baton Rouge: Louisiana State University Press, 1977), about the murders of civil rights workers Schwerner, Chaney, and Goodman in the summer of 1964, was a Book of the Month Club Alternate Selection.

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Lynn Eden Associate Director for Research Speaker CISAC
Michael May Professor Emeritus Speaker Stanford
Charles Perrow Research Fellow Speaker CISAC; Professor of Sciology (emeritus) Yale University
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