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BACKGROUND: Many hospitals enrolled in the American Heart Association's Get With The Guidelines (GWTG) Program achieve high levels of recommended care for heart failure, acute myocardial infarction (MI) and stroke. However, it is unclear if outcomes are better in those hospitals recognized by the GWTG program for their processes of care. METHODS: We compared hospitals enrolled in GWTG and receiving achievement awards for high levels of recommended processes of care with other hospitals using data on risk-adjusted 30-day survival for heart failure and acute MI reported by the Center for Medicare and Medicaid Services. RESULTS: Among the 3,909 hospitals with 30-day data reported by Center for Medicare and Medicaid Services 355 (9%) received GWTG achievement awards. Risk-adjusted mortality for hospitals receiving awards was lower for both heart failure (11.0% vs 11.2%, P = .0005) and acute MI (16.1% vs 16.5%, P < .0001) compared to those not receiving awards. After additional adjustment for hospital characteristics and noncardiac performance measures, the reduction in mortality remained significantly lower for GWTG award hospitals for acute myocardial infraction (-0.19%, 95% CI -0.33 to -0.05), but not for heart failure (-0.11%, 95% CI -0.25 to 0.02). Additional adjustment for cardiac processes of care reduced the benefit of award hospitals by 28% for heart failure mortality and 43% for acute MI mortality. CONCLUSIONS: Hospitals receiving achievement awards from the GWTG program have modestly lower risk adjusted mortality for acute MI and to a lesser extent, heart failure, explained in part by better process of care.

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Professor Joseph previously taught at Emory University, Dartmouth College, the University of California at Los Angeles, the University of Ibadan (Nigeria), and the University of Khartoum (Sudan). He has held research fellowships at Harvard University, Boston University, the Massachusetts Institute of Technology, the Institute of Development Studies (Sussex, UK), Chr. Michelsen Institute (Norway), and the Ecole des Hautes Etudes en Sciences Sociales (France). Joseph has devoted his scholarly career to the study of politics and governance in Africa with a special focus on democratic transitions, state building and state collapse, and conflict resolution.

He directed the African Governance Program at the Carter Center (1988-1994) and coordinated elections missions in Zambia (1991), Ghana (1992), and peace initiatives in Liberia (1991-1994). He has been a longtime member of the Council of Foreign Relations. Joseph is the recipient of numerous fellowships and awards including a Rhodes Scholarship, a Kent Fellowship, and a Guggenheim Fellowship. In 2002-03, he held visiting fellowships at the U.S. Institute of Peace and the National Endowment for Democracy. He was a Fulbright Scholar in France and a Fulbright Professor in Nigeria.

He has written and edited dozens of scholarly books and articles including Radical Nationalism in Cameroun (1977); Gaullist Africa: Cameroon Under Ahmadu Ahidjo (1978); Democracy and Prebendal Politics in Nigeria (1987); State, Conflict, and Democracy in Africa (1999); Smart Aid for African Development (2009) and the Africa Demos series (1990-94). His article, "Africa's Predicament and Academe", was published as a cover story by The Chronicle of Higher Education (March 7, 2003). One of his recent articles is "Challenges of a ‘Frontier' Region," Journal of Democracy, April 2008. Others are posted at www.brookings.edu/experts/josephr.aspx

» Joseph, Richard, "The Nigerian predicament" (NGR Guardian News)

Reuben W. Hills Conference Room

Richard Joseph John Evans Professor of Political Science Speaker Northwestern University
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Please join the Forum on Contemporary Europe for a first assessment of the September 27 German elections by FSI Senior Fellow Josef Joffe.

Josef Joffe is publisher-editor of the German weekly Die Zeit, and was previously columnist/editorial page editor of Sddeutsche Zeitung (1985-2000). Abroad, his essays and reviews have appeared in: New York Review of Books, New York Times Book Review, Times Literary Supplement, Commentary, New York Times Magazine, New Republic, Weekly Standard, Prospect (London), Commentaire (Paris). Regular contributor to the op-ed pages of Wall Street Journal, New York Times and Washington Post; Time and Newsweek.  In 2005, he co-founded the foreign policy journal "The American Interest" in Washington (with Zbigniew Brzezinski and Francis Fukuyama).

His most recent book is Überpower: America's Imperial Temptation (2006, translated into German and French). His articles have appeared in Foreign Affairs, The National Interest, International Security, The American Interest and Foreign Policy as well as in professional journals in Germany, Britain and France. He is the author of The Limited Partnership: Europe, the United States and the Burdens of Alliance, The Future of International Politics: The Great Powers; co-author of Eroding Empire: Western Relations With Eastern Europe.

 

Event Synopsis:

As Professor Joffe describes, political scientists predicting the outcome of the recent German elections based on economic factors were surprised by the victory of the Center Right, expecting a "Red-Red-Green" (Social Democrats-Left-Green Party) coalition instead of Merkel's "Black-Yellow" (Christian Democrats and Free Democrat) coalition party. He sees the outcome more as a loss for the Social Democrats, Lefts, and Greens - who should have done better in tough economic times, and capitalized on left-leaning ideology in Germany - than as a decisive victory for the winners.  He disagrees with the New York Times' declaration of a "mandate for change" in Germany for several reasons:

  1. The proportional representation party system based on coalitions rather than majorities makes it impossible to enact wholesale change
  2. The "stalemate system" features too many centers of power and makes change difficult
  3. Germans like these features of their political system too much to change them

Professor Joffe asserts that the outcome of the elections is a good one for Germany. A victory by the "Red-Red-Green" coalition would have brought about years of instability under a grand coalition that would be characterized by high taxes and spending, pacifism, and the status quo, and which would soon have broken down. In the coming years, Joffe predicts a medium-term exit of German troops from Afghanistan, resistance of US calls for more troops in the Middle East, a pro-Israel stance, and little to no change in domestic policy.  He believes there should be greater focus on preventing the collapse of social support programs, but admits this does not fit into the electoral cycle of domestic politics and will likely be overlooked.

In conclusion, Joffe views the election outcome as the best possible one given alternatives, and as a message to Angela Merkel that Germans are realistic and want German politicians to be less timid.

A discussion session following the talk addressed such issues as: Will Germany revise its position toward Turkey's EU integration under Merkel's leadership? Will the election outcome affect the competitive position of German business? How are rising debt levels in Europe felt by Germany? How do the German people feel about their economic situation and competitiveness?

Josef Joffe Speaker
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Martha Crenshaw will present a research project, "Mapping Terrorist Organizations," recently funded by NSF.

The purpose of the project is to identify patterns in the evolution of organizations that practice terrorism, specify the causes and consequences of these patterns, and analyze the development of Al Qaeda and its cohort in a comprehensive comparative framework.

The project analyzes the organizational structure of different families of organizations and traces their relationships over time. It will produce a series of dynamic maps of the architecture of violent and non-violent opposition groups operating in the same conflict theater.

It will also identify common patterns of organizational evolution, as groups form, split, merge, collaborate, compete, shift ideological direction, adopt or renounce terrorism, grow, shrink, and decline. Models based on comparisons of historical genealogies of terrorism will be applied to the case of Al Qaeda and its affiliates and associates, including the Afghani and Pakistani Taliban. Theories generated from the study will thus shed light on an important and constantly evolving national security threat.

The project will also identify or develop computer software to assemble, organize, and display information about organizations and their interactions over time.

Martha Crenshaw is a senior fellow at CISAC and FSI and a professor of political science by courtesy. She was the Colin and Nancy Campbell Professor of Global Issues and Democratic Thought and professor of government at Wesleyan University in Middletown, Conn., from 1974 to 2007. Her current research focuses on innovation in terrorist campaigns, the distinction between "old" and "new" terrorism, why the United States is the target of terrorism, and the effectiveness of counterterrorism policies.

She has written extensively on the issue of political terrorism; her first article, "The Concept of Revolutionary Terrorism," was published in the Journal of Conflict Resolution in 1972. Her recent work includes "Terrorism, Strategies, and Grand Strategies," in Attacking Terrorism (Georgetown University Press), "Terrorism and Global Security," in Leashing the Dogs of War: Conflict Management in a Divided World (United States Institute of Peace Press), and "Explaining Suicide Terrorism: A Review Essay," in the journal Security Studies. She is also the editor of a projected volume, The Consequences of Counterterrorist Policies in Democracies, for the Russell Sage Foundation in New York.

She served on the Executive Board of Women in International Security and chaired the American Political Science Association (APSA) Task Force on Political Violence and Terrorism. She has also served on the Council of the APSA and is a former President and Councilor of the International Society of Political Psychology (ISPP). In 2004 ISPP awarded her its Nevitt Sanford Award for Distinguished Scientific Contribution and in 2005 the Jeanne Knutson award for service to the society. She serves on the editorial boards of the journals International Security, Orbis, Political Psychology, Security Studies, and Terrorism and Political Violence. She coordinated the working group on political explanations of terrorism for the 2005 Club de Madrid International Summit on Democracy, Terrorism and Security. She is a lead investigator with the National Center for the Study of Terrorism and the Response to Terrorism (START) at the University of Maryland, funded by the Department of Homeland Security. She was a Guggenheim Fellow in 2005-2006. She served on the Committee on Law and Justice and the Committee on Determining Basic Research Needs to Interrupt the Improvised Explosive Device Delivery Chain of the National Research Council of the National Academies of Science. She was a senior fellow at the National Memorial Institute for the Prevention of Terrorism in Oklahoma City for 2006-2007.

Reuben W. Hills Conference Room

Martha Crenshaw Professor of Political Science (by courtesy) and Senior Fellow at CISAC and FSI Speaker
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Although its people are mainly Muslim, Malaysia is notably diverse.  Many communities of faith live together in relative harmony.  Yet ethnic tensions and decades of authoritarian rule have undermined national unity and a sense of shared purpose.  Since the watershed election of 2008, a revived political opposition and an active civil society have increasingly challenged the divisive politics of race and religion in Malaysia.  But severe obstacles still thwart full democratization and genuine pluralism. 

In his talk, Nik Nazmi Nik Ahmad will analyze the complexities of Malaysia’s race-based political system, the prospects of the country’s multiracial opposition, and what these dynamics imply for the future of democracy in Malaysia.

Nik Nazmi Nik Ahmad was elected to the Selangor State Assembly in Malaysia in March 2008 as a candidate of the opposition People’s Justice Party (Partai Keadilan Rakyat).  His roles in Keadilan include membership in the party’s National Youth Executive Committee.  In 2006-08 he served as private secretary to Keadilan’s de facto leader at the time, Anwar Ibrahim. 

Nik Nazmi is a columnist at the Malaysian Insider and the founder of SuaraAnum.com, a web magazine for young Malaysians.  He has been widely published in, and interviewed by, Malaysian and international media.  He read law and earned his LLB (Honors) from King's College, University of London.  While in London he joined British Muslims in protesting the occupation of Palestine and the war in Iraq.  His undergraduate work was done at the UEM Foundation College in Selangor, where he was elected president of the Student Council.  His secondary education was at the Malay College of Kuala Kangsar, which has been called “the Eton of the East.”  During his student career, he was active in multiple extra-curricular settings, including Muslim and social-service organizations and English-language debating teams.  He was born in Malaysia in 1982.

Daniel and Nancy Okimoto Conference Room

Nik Nazmi Nik Ahmad Selangor State Assemblyman and Political Secretary to the Chief Minister of Selangor, Malaysia Speaker
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In 2008 Medicare stopped reimbursing hospitals for treating eight avoidable hospital-acquired conditions. Using 2006 California data, we modeled the financial impact of this policy on six such conditions. Hospital-acquired conditions were present in 0.11 percent of acute inpatient Medicare discharges; only 3 percent of these were affected by the policy. Payment reductions were negligible (0.001 percent, or $0.1 million-equivalent to $1.1 million nationwide) and are unlikely to encourage providers to improve quality. Options to strengthen the incentives include further payment modifications for hospital-acquired conditions or expanding the hospital-acquired condition policy to exclude payment for consequences, additional procedures, and readmissions.

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Harold S. Luft
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Lisa Blaydes, CDDRL Affiliated Faculty, will receive the Gabriel A. Almond Award for her dissertation titled "Competition Without Democracy: Elections and Distributive Politics in Mubarak's Egypt." Mark F. Massoud, CDDRL Hewlett Fellow 2008-09, will receive the Edward S. Corwin Award for his dissertation titled "Who Rules the Law? How Government, Civil Society, and Aid Agencies Manipulate Law in Sudan."  The awards will be given out at the upcoming 2009 APSA Annual Meeting in Toronto.

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This seminar examines possible explanations for a striking anomaly in the distribution of democracies around the world. While 60 percent of all the independent states in the world are at least electoral democracies, the Arab world is alone among major regions in lacking a critical mass of democracies. In fact, not a single one of the states of the Arab Middle East is classified by Freedom House as a democracy today. This presentation examines possible cultural, historical, economic, political, institutional, and geostrategic explanations for the democracy deficit in the Arab world. Rejecting some of these possible explanations as implausible or untenable, it affirms others and considers what factors might foster transitions to constitutional democracy in the Arab world.

Summary
Larry Diamond's presentation explored the question of why there is no Arab democracy in the Middle East and North Africa. Using Freedom House panel data, he demonstrated the relatively stagnant levels of democratic freedoms that have typified this authoritarian slice of geography for the last several decades: only two countries out of nearly twenty could be considered electoral democracies, and these were the non-Arab states of Turkey and Israel. He next sifted through several potential explanations for the absence of democratization.

The first was the culturalist thesis, that something inherent within Islam or Arab culture precludes the formation of a genuinely democratic set of institutions and values. However, the presence of democracy in other non-Western regions casts doubt on this contention. The second was economic development, a popular variable often correlated with democratic transitions; however, Arab autocracies each have analogues in other regions with similar levels of development but with democratic governments. More plausibly, a variety of political and institutional variables lay at the heart of the problem. For one, these regimes have become extremely adept at repressing dissidents and reformists within their societies. For another, they have adopted an adaptable ecology of liberalization, in which short bursts of political reform relieve temporary demands for reform while leaving intact executive monopolies over state resources. Further, they efficiently divide opposition parties and civic forces, often by imposing electoral rules and regulations that make it impossible for civil society-which is generally weak and fragmented-to mount concerted campaigns against the state apparatus. Finally, the dual conundrums of Islamism and the Arab-Israeli conflict play into each regime's survival strategy.

Authoritarian incumbents play up the nightmare of Islamic extremists gaining power to curry favor with the West and delay reforms; they also use the Palestinian issue to defuse popular grievance by way of rechanneling indignation against Israel.

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Mosbacher Senior Fellow in Global Democracy at the Freeman Spogli Institute for International Studies
William L. Clayton Senior Fellow at the Hoover Institution
Professor, by courtesy, of Political Science and Sociology
diamond_encina_hall.png MA, PhD

Larry Diamond is the William L. Clayton Senior Fellow at the Hoover Institution, the Mosbacher Senior Fellow in Global Democracy at the Freeman Spogli Institute for International Studies (FSI), and a Bass University Fellow in Undergraduate Education at Stanford University. He is also professor by courtesy of Political Science and Sociology at Stanford, where he lectures and teaches courses on democracy (including an online course on EdX). At the Hoover Institution, he co-leads the Project on Taiwan in the Indo-Pacific Region and participates in the Project on the U.S., China, and the World. At FSI, he is among the core faculty of the Center on Democracy, Development and the Rule of Law, which he directed for six and a half years. He leads FSI’s Israel Studies Program and is a member of the Program on Arab Reform and Development. He also co-leads the Global Digital Policy Incubator, based at FSI’s Cyber Policy Center. He served for 32 years as founding co-editor of the Journal of Democracy.

Diamond’s research focuses on global trends affecting freedom and democracy and on U.S. and international policies to defend and advance democracy. His book, Ill Winds: Saving Democracy from Russian Rage, Chinese Ambition, and American Complacency, analyzes the challenges confronting liberal democracy in the United States and around the world at this potential “hinge in history,” and offers an agenda for strengthening and defending democracy at home and abroad.  A paperback edition with a new preface was released by Penguin in April 2020. His other books include: In Search of Democracy (2016), The Spirit of Democracy (2008), Developing Democracy: Toward Consolidation (1999), Promoting Democracy in the 1990s (1995), and Class, Ethnicity, and Democracy in Nigeria (1989). He has edited or coedited more than fifty books, including China’s Influence and American Interests (2019, with Orville Schell), Silicon Triangle: The United States, China, Taiwan the Global Semiconductor Security (2023, with James O. Ellis Jr. and Orville Schell), and The Troubling State of India’s Democracy (2024, with Sumit Ganguly and Dinsha Mistree).

During 2002–03, Diamond served as a consultant to the US Agency for International Development (USAID) and was a contributing author of its report, Foreign Aid in the National Interest. He has advised and lectured to universities and think tanks around the world, and to the World Bank, the United Nations, the State Department, and other organizations dealing with governance and development. During the first three months of 2004, Diamond served as a senior adviser on governance to the Coalition Provisional Authority in Baghdad. His 2005 book, Squandered Victory: The American Occupation and the Bungled Effort to Bring Democracy to Iraq, was one of the first books to critically analyze America's postwar engagement in Iraq.

Among Diamond’s other edited books are Democracy in Decline?; Democratization and Authoritarianism in the Arab WorldWill China Democratize?; and Liberation Technology: Social Media and the Struggle for Democracy, all edited with Marc F. Plattner; and Politics and Culture in Contemporary Iran, with Abbas Milani. With Juan J. Linz and Seymour Martin Lipset, he edited the series, Democracy in Developing Countries, which helped to shape a new generation of comparative study of democratic development.

Download full-resolution headshot; photo credit: Rod Searcey.

Former Director of the Center on Democracy, Development and the Rule of Law
Faculty Chair, Jan Koum Israel Studies Program
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Larry Diamond Director, CDDRL; Senior Fellow at the Freeman Spogli Institute and the Hoover Institution and Professor of Political Science and Sociology, by courtesy Speaker
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