When I first visited Kawasaki City, I was immediately struck by the multicolored character for 川or “kawa” (river) in the Chinese characters for川崎 (Kawasaki) that appears on signs, buildings, posters, and even storm drain covers. I learned from Kawasaki Mayor Norihiko Fukuda that the multicolored 川 symbolizes the importance that Kawasaki City places upon diversity.

Kawasaki City is a large industrial city in the greater Tokyo area with a population of approximately 1.5 million, making it Japan’s sixth most populous city after Tokyo. It is one of Japan’s most ethnically diverse cities. Many Japanese multinational companies are based in Kawasaki. In 2014, the U.S. multinational company Johnson & Johnson opened the Tokyo Science Center in Kawasaki.

With the vision of Mayor Fukuda and support from Kawasaki City, SPICE has launched Stanford e-Kawasaki, an online course that is offered to high school students in Kawasaki. Stanford e-Kawasaki’s main course topics are diversity and entrepreneurship. Stanford e-Kawasaki Instructor Maiko Tamagawa Bacha recently noted, “The Kawasaki students have shown strong interest in these timely and relevant topics and are always actively engaged in discussions. One of the great things about Stanford e-Kawasaki is that it provides a place where students feel free and encouraged to express themselves. It also provides an important opportunity for students to reflect on their own society by learning about the United States. I look forward to our continued learning together for the rest of the course.” The course began in fall 2019 and a closing ceremony will be held in March 2020.

Maiko Tamagawa Bacha

Like Bacha, Mayor Fukuda has also done formal studies in the United States. As a graduate of Furman University in South Carolina, Mayor Fukuda experienced life in the United States firsthand. Mayor Fukuda reflected, “I am grateful to SPICE at Stanford University… for starting this program for high school students in Kawasaki City. I am encouraged to learn that the students are actively learning and engaged in discussions on topics related to diversity and entrepreneurship. I strongly hope that they will grow to be men and women of high caliber, who are keen to experience their lives with broad perspectives.” With the presence of many multinational corporations in Kawasaki, Mayor Fukuda witnesses the interdependence of Japan and the world every day and fully appreciates the significance of topics like diversity and entrepreneurship to the U.S.–Japan relationship.

The SPICE staff would like to express its appreciation also to Hisashi Katsurayama from the Kawasaki Board of Education and Yoshitaka Tsuchihama and Miyuki Kitamura of Kawasaki City and for their unwavering support of Stanford e-Kawasaki.

To stay informed of news about Stanford e-Japan and SPICE’s other programs, join our email list and follow us on Facebook, Twitter, and Instagram.

Elderly patients hospitalized with congestive heart failure have a poor prognosis and high risk of death and hospital readmission. So, their post-discharge care can strongly influence their outcomes.

Yet despite data showing that transitional care interventions, such as home visits by nurses, can reduce death rates and hospital readmission by more than 30%, many health systems have not implemented such programs. Health policy experts say this is due in part to cost concerns and doubts about the effectiveness of these delivery services.

 Now, a team of Stanford Medicine and Veterans Affairs researchers has sought to assess whether transitional care interventions provide good value and better outcomes, as there are 5 million people living with congestive heart failure in the United States and 500,000 new cases diagnosed each year. CHF is the stage of chronic heart disease in which fluids build up around the heart, causing it to pump inefficiently.

The researchers updated a 2017 study on the impact of transitional care intervention with four years of additional data. They then used it to compare standard post-discharge management with three post-discharge regimes for patients 75 or older that they found to be most effective: disease management clinics, nurse home visits and nurse case management.

All three transitional care interventions delivered appreciable health benefits to the patient population, said Jeremy Goldhaber-Fiebert, PhD, associate professor of medicine at the Stanford School of Medicine and core faculty member of Stanford Health Policy.

The findings were published in the Annals of International Medicine. Goldhaber-Fiebert is the senior author. The lead authors are Manuel R. Blum, MD, MS in Epidemiology & Clinical Research at Stanford in 2019 and now at the Department of General Internal Medicine at the University Hospital of Bern; Henning Øien, PhD, Norwegian Institute of Public Health, Oslo; and Harris L. Carmichael, MD, a Stanford/Intermountain Fellow in Population Health, Delivery Science, and Primary Care

“Transitional care interventions for older individuals with congestive heart failure — particularly nurse home visits — offer a high-value care alternative that could improve the health and longevity of millions of Americans,” he said.

The researchers said these transitional care services should become the standard of care for post-discharge management of patients with heart failure.

Heart failure causes 1 in 8 deaths nationwide

The prevalence of heart failure is estimated to be 26 million people worldwide and growing. In the United states, heart 5.7 million adults have been diagnosed with HF, with an estimated annual direct cost of $39.2 billion to $60 billion. Total heart failure costs in the United States are expected to exceed $70 billion by 2030, the authors wrote. According to the Centers for Disease Control and Prevention, heart disease costs the United States about $219 billion each year from health-care services, medicines and lost productivity.

Of the 15 million Americans in their mid-70s to 80s today, about 1 million suffer heart failure.

“So population gains from more effective post-discharge care would be hundreds of thousands of life years,” Goldhaber-Fiebert said. “Likewise, tens of thousands of costly rehospitalizations could be prevented each year if these interventions were delivered successfully.”

Heart failure primarily affects older people and is the second-most common inpatient diagnosis billed to Medicare. Yet the authors cite a recent study of 18 million Medicaid charges which found that only 7% of eligible patients at risk of rehospitalization received transitional services.

The standard post-hospital care for those patients includes sending them home with some advice and scheduling follow-up visits for them with cardiologists within 14 days of discharge. The researchers found that patients who received this standard post-hospitalization care with an average age of 75 had an average life expectancy of 2.9 years and 2.9 hospitalizations during their remaining lifetime. In comparison, nurse home visits decreased the number of hospitalizations by 10 readmissions per 100 patients and increased life expectancy by approximately four months, the study found.

“If these interventions were successfully implemented at scale, they could provide important substantial benefits with very good value,” said co-author Douglas Owens, MD, the Henry J. Kaiser Jr. Professor and professor of medicine at Stanford.

Reduced hospitalizations for congestive heart failure, according to the research, produces substantial cost savings that partially offset the costs of delivering the interventions. Though nurse home visits increase lifetime health care costs by $4,622, the substantial health benefits that they deliver justify their costs: $19,570 quality adjusted life years gained, which is considered highly cost-effective.

Hospital and insurance administrators take note

“Our results have important implications for decision-makers in hospital administration as well as in insurance and policy settings,” the authors wrote. They concluded:

• Transitional care services should become the standard of care for post-discharge management of patients with heart failure;
• The increasing reimbursement restrictions and regulations affecting HF hospital readmissions, through such programs as the Centers for Medicare & Medicaid Services Hospital Readmission Reduction Program, makes this research particularly informative to decision-makers;
• Hospital administrators could use the research to determine which transitional services are most cost-effective for its rural population, overall patient base and hospital system.

The other Stanford researcher on the study was Paul Heidenreich, MD, a professor of medicine and health research and policy at the Stanford University School of Medicine and, by courtesy, professor of health research and policy at the Palo Alto Veterans Affairs Health Care System.

In a recent interview with People's Daily Online, APARC Fellow Thomas Fingar reflects on some of the milestones in the developing and diversifying relationship between the United States and China over the past forty years. The interview is part of a series of short documentaries produced by People's Daily Online West USA to commemorate the 40th anniversary of the establishment of formal diplomatic relations between the United States and China in 1979. The series was premiered at the San Francisco Public Library on January 18, 2020.

"So much of my career has been devoted to this relationship, [to] making this relationship work," says Fingar. He recounts how his own interest in China was sparked as a student in an anthropology class, where he began trying to understand why China and the United States "did things differently."

That initial question led him to a lifetime of building connections between the two countries, both in academia and government. Fingar was instrumental in launching Stanford's U.S.-China Relations Program in 1975, which promoted the exchange of learning, technology, and training between U.S. academics and students and their Chinese counterparts.

The focus on promoting U.S.-China engagement continues to inform Fingar’s perspectives today. "I'm concerned about the relationship [between the U.S. and China], but I'm not worried about it. I'm confident that both sides understand the stakes, [and] both sides understand the pressures to make this work".

Watch the interview below:

Speaking on Monday about Donald Trump’s impeachment trial, Ukraine’s foreign minister said “please don’t drag us into your [America’s] internal political processes.”  Unfortunately, Republicans appear intent on doing precisely that, as they repeat the false Russian claim that the Ukrainian government interfered in the 2016 US election.

Republicans see this as part of their effort to defend President Trump. In doing so, they put at risk America’s long-standing support for its Ukrainian partner.

The US government and large bipartisan majorities in Congress have backed Ukraine since the early 1990s, when it regained independence following the Soviet Union’s collapse. By the end of the decade, Congressionally-approved assistance for Ukraine had reached USD 300-400 million per year.

When Ukrainians took to the streets in the 2004 Orange Revolution and the 2013-2014 Revolution of Dignity, their striving for democracy won interest and support from both sides of the aisle on Capitol Hill.

Such Congressional support offered Kyiv grounds for comfort when Trump became president in 2017. Candidate Trump had suggested he might recognize the illegal 2014 annexation of Crimea by Russia. He also questioned the sanctions imposed on Moscow for its seizure of Crimea and subsequent aggression in eastern Ukraine.

Despite Trump’s apparent skepticism about Ukraine and his reluctance to criticize Vladimir Putin (or Russian actions), Congress continued to back Ukraine. It regularly voted by wide margins to approve funding for reform and military assistance for Kyiv while pressing the administration to bolster sanctions on Russia.

Things took a turn last September with the revelation of Trump’s effort to extort Ukraine’s president into investigating his possible 2020 political opponent by withholding an Oval Office visit and military assistance. The president’s alleged abuse of power led to his impeachment by the House of Representatives in December.

I tried to assure my Ukrainian interlocutors that, whatever President Trump did, they had an ace in the hole: the bipartisan support their country enjoyed from both Democrats and Republicans in Congress. This was support that, if necessary, would produce veto-proof votes to aid Ukraine. Today, I am not so sure.

It has long been clear that Trump buys Moscow’s disinformation line that Ukraine, not Russia, interfered in the 2016 US election. It is true that individual Ukrainian officials criticized candidate Trump, just as officials from many European countries did. But it was Russian intelligence agencies, with Putin’s approval, that hacked the Democratic National Committee’s e-mails and gave them to Wikileaks. It is Russia’s Internet Research Agency that used social media to sow division among Americans.

However, in November and December as they sought to defend Trump against impeachment, Republicans began to make the Russian argument that Ukraine had interfered. There were many examples of this from Republicans who will sit in judgment as the Senate conducts the impeachment trial. Senator John Kennedy (R-LA) commented, “I think both Russia and Ukraine meddled in the 2016 election.” Meanwhile, Senator Richard Burr (R-NC) argued, “There’s no difference in the way Russians put their finger early on, on the scale and how Ukrainian officials did it,” and Senator Ted Cruz (R-TX) stated bluntly, “Ukraine blatantly interfered in our election.”

We can expect more such charges in the coming days. Republicans have put themselves on a slippery slope as regards support for Ukraine.

Will Republicans who assert that the Ukrainian government interfered in the US election vote in the future to approve assistance for Ukraine? And, if they can separate their espousal of the Kremlin’s talking point from their votes on assistance, how do they defend to constituents and others less sympathetic to Ukraine a vote to assist the country that they say interfered in the 2016 US election?

This is dangerous ground that could undermine US support for a country whose success is in America’s national interest.

Steven Pifer, a William Perry research fellow at Stanford’s Center for International Security and Cooperation, is a former US ambassador to Ukraine.

Read the Rest at The Atlantic Council

On a recent Friday afternoon at Stanford, the weather reminded me of some crisp yet clear winter days in Japan. The sun brightly lit the Falcon Lounge on the 5th floor of Encina Hall as six alumni from the 2014 to 2018 Reischauer Scholars Program (RSP) and Sejong Korean Scholars Program (SKSP) cohorts gathered to celebrate the new year. This annual shinnenkai (literally, “new year gathering,” in Japanese) luncheon offers alumni of SPICE’s pre-collegiate online courses to meet or reconnect over lively conversation and delicious food. For the SPICE instructors, the shinnenkai is often the first time to meet alumni in person.

The RSP is an online course on Japan and U.S.–Japan relations that is offered to U.S. high school students each spring, and will welcome its seventeenth cohort in a few weeks. The SKSP is preparing for its eighth cohort, and offers an intensive online study of Korea and U.S.–Korea relations to U.S. high school students. SPICE also offers a third online course to U.S. high school students on China and U.S.–China relations, the China Scholars Program. The CSP is preparing for its sixth cohort.

One of the attendees, James Noh (RSP ‘16, Stanford University ‘22), reflected on his RSP experience following the shinnenkai: “My RSP experience not only nurtured my interest in East Asia, but also made me realize that I wanted to incorporate my interest in East Asia into both my academic and professional careers. Looking back, I think participating in RSP played an important role in influencing my decision to take a gap year to study Mandarin in China after high school and major in international relations with a focus on East Asia.” During the shinnenkai, it was interesting to hear other alumni share thoughts on how their experiences in the RSP and SKSP helped to prepare them for and also shape their college life. Comments ranged from “informing choices” like class or major selection to “honing skills” like writing research papers.

Through the many years in which SPICE has engaged U.S. high school students in these intensive online courses, we have been fortunate to work with many exceptional students such as James. As the instructor of the RSP, I especially treasure the face-to-face opportunities to meet with alumni of these courses. These opportunities are rare treats given that our courses take place entirely online. The annual shinnenkai is truly a highlight of my year.

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Related articles:

• Honoring High School Students from Japan and the United States: A Glow for Global Peace
• Applications Now Open: Stanford Online Courses for High School Students on China, Korea, and Japan
• Twenty High School Students Accepted into Stanford Online Course on Modern China

In a story released on Christmas Day, 2019, the Washington Post reported that U.S. Cyber Command is “developing information warfare tactics that could be deployed against senior Russian officials and oligarchs if Moscow tries to interfere in the 2020 U.S. elections through hacking election systems or sowing widespread discord.” According to this story, one option being explored is the targeting of “senior leadership and Russian elites (though probably not President Vladimir Putin, which would be considered too provocative)” to demonstrate that the “sensitive personal data” of these individuals could be hit if the election interference did not stop. The Post article also quotes Lawfare’s Bobby Chesney saying that such actions would send “credible signals to key decision-makers that they are vulnerable if they take certain adversarial actions.” Photo: U.S. Cyber Command Public Affairs

Read the Rest at The LawFare Blog