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Abstract

OBJECTIVES:

To estimate the potentially inappropriate use of implantable cardioverter-defibrillator ICDs in older U.S. adults.

DESIGN:

Retrospective study.

SETTING:

The National Cardiovascular Data ICD Registry.

PARTICIPANTS:

Forty-four thousand eight hundred five individuals in the National Cardiovascular Data's ICD Registry(™) who had received ICDs for primary prevention from January 2006 to December 2008. Individuals with a prior myocardial infarction and ejection fraction less than 30% were included.

MEASUREMENTS:

Mortality risk was categorized using the Multicenter Automatic Defibrillator Implantation (MADIT) II risk-stratification system. Low-risk and very-high-risk individuals were considered potentially inappropriate recipients.

RESULTS:

Of 44,805 individuals, 67% (n=29,893) were aged 65 and older, of whom 51% were aged 75 and older. A significant proportion of ICD recipients had a low risk of death (16%, n=6,969) or very high risk of nonarrhythmic death (8%, n=3,693). Potentially inappropriate ICD use was 10% in those aged 75 and older, much less than in younger groups (40%,

CONCLUSION:

Potentially inappropriate ICD use appears significantly less-and at modest rates-in older Americans than in younger age groups. Overall, almost one-quarter of individuals may have received ICDs inappropriately based on their risk of death. Physicians appear to be conservatively referring older adults and wisely deferring those with high comorbid burden.

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Journal of the American Geriatrics Society
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Mary K. Goldstein
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2011
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WTO Disciplines on Agricultural Support: Seeking a Fair Basis for Trade. Cambridge UK: Cambridge University Press
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An excerpt from "Implementing Change: Organizational Challenges" (pp. 309-310):

Improving organizational performance is never easy. As sociologist Jim March has noted, success requires that organizations balance exploration the search for new ways of doing things with exploitation, the ability to harness new practices and jettison older, less effective ones (March, 1991). These challenges confront all organizations, but two factors make them more acute for intelligence agencies. The first is bounded rationality (Simon, 1976). In the theoretical world, individuals have the luxury of perfect rationality, seeing all of the relevant options, assessing trade-offs with clarity, and making the best decisions. The real world is not as nice. There, rationality is inherently limited or bounded by uncertainty, imperfect information, and cognitive constraints that lead individuals to make decisions that appear to be “good enough”—but may turn out to be nowhere close (Simon, 1976). Intelligence officials have the toughest time of all, confronting bounded rationality problems in spades. Their job is to give policy-making customers decision advantage amidst swirling uncertainty, missing information, enemy deception and denial, and fast-changing events that are often unforeseeable, even to the participants themselves.

The second acute intelligence challenge is secrecy. As I discuss below, the more specialized any organization becomes, the harder it is for any one part of the organization to understand or improve what another part is doing, a phenomenon that sociologists call “structural secrecy” (Vaughan, 1996). In the classified universe, of course, this structural secrecy is compounded by actual secrecy, which protects vital information from adversaries, but also compartmentalizes information, ideas, organizations, and practices to a much greater extent.

Despite the intelligence community’s (IC’s) unique challenges, the fields of organization theory and political science offer useful insights and cautionary warnings about the organizational side of improving intelligence analysis. The chapters in Part II (Analytic Methods) of this volume mine an array of relevant literature for the best analytic tools to improve intelligence analysis. Here, we turn to a different task: Examining a broad sweep of relevant social science research with an eye to identifying which organizational factors impede or facilitate effective analysis. Worth underscoring, though, is the fact that social science does not offer ready-made instructions about how to make intelligence analytic improvements stick. However, it does offer some useful generalizations that can illuminate the trade-offs and challenges involved to guide more effective implementation.

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The National Academies Press
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Amy Zegart
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0-309-17698-0
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Michael A. McFaul, a Stanford political science professor and senior fellow at the university’s Freeman Spogli Institute for International Studies, was confirmed by the Senate to be the next ambassador to Russia. 

McFaul, President Barack Obama’s top advisor on Russia and a Bing Senior Fellow at Stanford’s Hoover Institution, will succeed John Beyrle.

"Mike will bring to his new posting in Moscow the same intensity, clarity of vision and imagination that he demonstrated as President Obama's point person on Russia at the White House," said Coit D. Blacker, FSI’s director and the Olivier Nomellini Professor in International Studies. 

The Dec. 17 voice vote confirming McFaul came on the last day the Senate was in session before its winter break. Sen. Mark Kirk, R-Ill., had held up McFaul's approval over issues with U.S. policies toward Russia.

During confirmation hearings before the Senate Foreign Relations Committee in October, McFaul discussed the overall status of U.S.-Russian relations, missile defense, arms reduction agreements and trade relations.

Since the beginning of the Obama administration, McFaul has been the special assistant to the president for national security affairs and senior director for Russia and Eurasia at the National Security Council.

He served as senior adviser on Russia and Eurasia to Obama during the presidential campaign and continued to advise on foreign policy issues during the transition.

The Obama administration has achieved new momentum in relations with Russia with McFaul's involvement.

The two countries have signed the New Start arms control treaty, which calls for significant cuts in nuclear arsenals; finalized a civilian nuclear cooperation pact; forged agreement on tougher sanctions on Iran; and expanded the supply route to Afghanistan through the territory of the former Soviet Union.

The two powers now turn to the efforts to forge cooperation on missile defense in Europe and to gain Russia's admission to the World Trade Organization, as well as the challenges posed by Iran and Libya.

"This is a complex and sensitive time in the ever-evolving relationship between the United States and the Russian Federation," Blacker said. "Having an ambassador in place who gets the relationship has never been more important. For this reason above all others, Mike is the perfect choice. We are all deeply proud of Mike and all that he has accomplished."

McFaul, who has served as FSI’s deputy director and director of the institute’s Center on Democracy, Development, and the Rule of Law, received a bachelor’s degree in international relations and Slavic languages and an master’s in Slavic and East European studies from Stanford in 1986. He was awarded a Rhodes Scholarship to Oxford, where he completed his PhD in international relations in 1991.

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Background

Cardiovascular diseases represent an increasing share of the global disease burden. There is concern that increased consumption of palm oil could exacerbate mortality from ischemic heart disease (IHD) and stroke, particularly in developing countries where it represents a major nutritional source of saturated fat.

Methods

The study analyzed country-level data from 1980-1997 derived from the World Health Organization's Mortality Database, U.S. Department of Agriculture international estimates, and the World Bank (234 annual observations; 23 countries). Outcomes included mortality from IHD and stroke for adults aged 50 and older. Predictors included per-capita consumption of palm oil and cigarettes and per-capita Gross Domestic Product as well as time trends and an interaction between palm oil consumption and country economic development level. Analyses examined changes in country-level outcomes over time employing linear panel regressions with country-level fixed effects, population weighting, and robust standard errors clustered by country. Sensitivity analyses included further adjustment for other major dietary sources of saturated fat.

Results

In developing countries, for every additional kilogram of palm oil consumed per-capita annually, IHD mortality rates increased by 68 deaths per 100,000 (95% CI [21-115]), whereas, in similar settings, stroke mortality rates increased by 19 deaths per 100,000 (95% CI [-12-49]) but were not significant. For historically high-income countries, changes in IHD and stroke mortality rates from palm oil consumption were smaller (IHD: 17 deaths per 100,000 (95% CI [5.3-29]); stroke: 5.1 deaths per 100,000 (95% CI [-1.2-11.0])). Inclusion of other major saturated fat sources including beef, pork, chicken, coconut oil, milk cheese, and butter did not substantially change the differentially higher relationship between palm oil and IHD mortality in developing countries.

Conclusions

Increased palm oil consumption is related to higher IHD mortality rates in developing countries. Palm oil consumption represents a saturated fat source relevant for policies aimed at reducing cardiovascular disease burdens.

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On December 6, the Program on Arab Reform and Democracy at the Center on Democracy, Development, and the Rule of Law together with the Safadi Foundation USA inaugurated the Safadi-Stanford Initiative for Policy Innovation (SSIPI) at a conference hosted by the Woodrow Wilson International Center for Scholars in Washington, DC and supported by the Center for International Private Enterprise. This gathering convened an upwards of 100 guests to explore the conference's theme of economic reform and development in the Arab world.  

The keynote addresses were delivered by IMF Head Christine Lagarde who commented on the economic landscape in the region and suggested methods to stimulate growth for emerging Arab economics, and Lebanese Finance Minister Mohammad Safadi who stressed the importance of institution building and transparent accountable governance practices for development in the region, particularly in relation to how Arab governments handle international aid.

Safadi Scholar of the Year Katarina Uherova Hasbani presented the findings of a research study she authored on electricity sector reform in Lebanon while in residence at CDDRL this fall. The SSIPI research partnership was initiated to promote policy-relevant research on Lebanon and supported Hasbani's visiting fellowship at Stanford. Hasbani, an energy policy expert, presented her findings to the policy- making community, arguing that reliable and stable electricity supplies are a pre-condition for economic development. Hasbani cautioned that the failing electricity sector in Lebanon threatens the country's progress diverting resources from social development and education.

Deputy Assistant Secretary of State for Near Eastern Affairs Tamara Wittes and Mara Rudman, Assistant Administrator for the bureau for Middle East at USAID, both commented on the development challenges and opportunities that lie in the wake of the Arab Spring. "What is happening in the region is about the people writing their own story," said Wittes. "The United States has to approach this with a sense of humility but we have a role to play because we are a major presence in the region." Rudman added that USAID is reaching out to new audience and partners in Egypt, many of whom are outside Cairo, to engage new actors after the January 25 revolution.

Miriam Allam, an economist with the OECD and Safadi Scholar first runner-up stressed the importance of public consultation and good regulation as best practices for cultivating active and democratic citizenship. Undersecretary of State for Economic, Energy, and Agricultural Affairs Robert D. Hormats, underscored the fact that economic reform must match social and political change in the region to create diverse economies that support growth, investment, and trade.

Inger Anderson, Vice-President for MENA at the World Bank, commented on the funding shortages from European countries that are resulting in decreased investment in the Arab world, when they need it the most. Both Anderson and Lagarde advocated for the reform of government subsidies, according to Lagarde, "governments need sustainable fiscal policies, including better targeted subsidies to help low-income groups."

Lagarde added that a key way forward is encouraging private sector investment to spur job creation but stressed that this requires predictability, a stable legal and tax environment, absence of corruption, and the elimination of regulatory loopholes.

Through this conference and ongoing research, the Safadi-Stanford Initiative for Policy Innovation seeks to offer new approaches and recommendations to advance development and governance practices in the region.

Transcript and video of event:

http://www.wilsoncenter.org/event/the-middle-the-storm-development-and-governance-the-arab-world

Speech by IMF Managing Director Christine Lagarde:

http://www.imf.org/external/np/speeches/2011/120611.htm

 

 

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This closed-door symposium is co-organized by Japan's Ministry of Economy, Trade and Industry (METI), the US Embassy in Japan, SPRIE-Stanford Project on Japanese Entrepreneurship (STAJE) of Stanford University, and the University of Tokyo (Science Entrepreneurship and Enterprise Development SEED, Division of University Corporate Relations DUCR). The event in 2012 will focus on new generation Japanese entrepreneurs and the central role of venture capital in Japan's entrepreneurial ecosystem. SPRIE faculty co-director Professor Bill Miller, and SPRIE-STAJE project leader Robert Eberhart will serve as discussants/commentators at the event.

For information about the 2011 Symposium, please click here for the press release by the U.S. Department of State, and here for more details.

The University of Tokyo, Japan

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