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The first Liberation Technology seminar of the winter quarter on January 6, featured Jonathan Zittrain, Professor of Law at Harvard Law School and co-founder of the Berkman Center for Internet & Society at Harvard University. Zittrain focused his talk entitled, Minds for Sale, on the variety of online platforms that harness the wisdom of crowds today, and closed with a discussion of the implications of these platforms. Categorizing these new tools by the breadth of their user base, Zittrain began by describing the platforms that pay the most money per task, require the most skill, and subsequently have the least participation. Key examples of these platforms are listed below, and organized by their decreasing level on skill.

  •  Xprize Foundation attempts to prompt radical breakthroughs through competitions for large quantities of prize money.
  • InnoCentive creates a marketplace between engineers and scientists to encourage innovation.
  • LiveOps, which bills itself as a contact center cloud, has developed a large set of independent contractors who are designated specific tasks when they sign in to the site. They may be assigned to answer calls placed to a restaurant or emergency hotline or to make political calls on behalf of Liveops clients.
  • Samasource offers "dignified digital work for women, children and refugees" located in developing countries.
  • Amazon Mechanical Turk (also known as Artificial Artificial Intelligence) allows users to participate in anonymous, minimally paid tasks. These tasks can be submitted by any party and are highly disaggregated among hundreds or thousands of users, each of whom receives a payout of between approximately one to fifteen cents for completing the task.
  • Soylent, which calls itself "a word processor with a crowd inside" embeds workers from Mechanical Turk into Microsoft Word. When users install the site's Shortn add-in into Microsoft Word, they can use the tool to have written samples shortened in two minutes. In order to achieve this, the written sample is disaggregated by paragraphs, and each paragraph is shortened within two minutes by a "Turker"-a user who accepts the task on Mechanical Turk.
  • Microtask enables disaggregating previously sensitive data to be work processed from a scanned image. The ultimate goal of this group is to put distributed work into video and computer games. For now, they disaggregate larger tasks into two-second tasks that can be distributed across a crowd.
  • Games With A Purpose (GWAP) has a game-like platform designed to get users to complete disaggregated tasks for virtual points, rather than for actual remuneration. One of its more popular activities quickly attracted 23,000 players who contributed 4.1 million labels to images they were presented with in The ESP Game. Many players routinely play more than 20 hours a week.

Next, Zittrain moved on to offer some additional examples, hypothetical scenarios and questions that highlight some of his own concerns about the potential of these technologies. One key question is whether this market may be too efficient at linking up solvers and payers, if certain tasks are not in fact beneficial for society. After all, it was highly contentious when Texas governor Rick Perry set up video cameras on Texas' border with Mexico and invited people to watch the video feeds and report if they saw anything suspicious. Similarly, a site called InternetEyes allows users to watch video feed from CCTV cameras in the UK for free, offering the chance to "earn reward money, have a chance at reducing crime, and potentially become a hero and save lives," instead of actual compensation.

In another example, the University of Colorado Police Department recently offered a $50 reward for identification of students shown to be smoking marijuana in photos from a large April 20 gathering. Hypothetically, the Iranian government could use Turkers to identify Iranian protestors through national ID photographs in the very same way; by Zittrain's calculations, this task could be disaggregated and carried out quickly at a cost of only $17,000 per protester identified.

Another cluster of issues relates to the use of anonymous users to carry out disaggregated tasks that may have the effect of exerting influence on others. For example, Turkers were recently offered the opportunity to write a positive 5 out of 5 review for a product on a website, which hundreds accepted and completed for a few cents at a time. Users on SubvertandProfit.com are paid to "Like" something on Facebook, "Digg" something, or show their approval of a site or product via some other social network. The users are remunerated for their effort, and the site also profits. Taking this a step further, these platforms also enable users to pay people to evince opinions on legislative issues they do not actually care about. For example, health insurers were recently caught paying Facebook gamers virtual currency to oppose the health reform bill. By enabling any task to be disaggregated and monetized, these new platforms can have highly controversial and unethical implications.

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Shorenstein APARC
Stanford University
Encina Hall, Room C335
Stanford, CA 94305-6055

(650) 736-0771 (650) 723-6530
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2011 Shorenstein-Spolgi Fellow in Comparative Health Policy
Qiulin_Chen3x4.jpg MA, PhD

Qiulin Chen is a postdoctoral fellow of Shorenstein APARC and a member of the center's Asia Health Policy Program. His main interest of research is health economics and public finance, focusing on policy and outcome comparison of health care systems and Chinese health reform. His dissertation focused on performance comparison between public (or governmental) and private health care financing, between local and central government responsibility on health care, between contracted and integrated health care system. In particular, his dissertation examined under Chinese-style decentralization, known as fiscal decentralization with political centralization, how economic competition affect local government's behaviour on health investment, and why public contracted system obstructs health performance and provides one channel of such effects in terms of preventive care and public health. He is currently involved in a comparative research project on demographic change in East Asia based on the National Transfer Accounts data and analysis.

Chen's recent publication is "The changing pattern of China's public services" (with Ling Li and Yu Jiang) in Population Aging and the Generational Economy: A Global Perspective (Ronald Lee and Andrew Mason, editors), forthcoming 2011. Before studying in Stanford, he has published more than 10 papers in academic journals in Chinese, such as Jing Ji Yan Jiu (Economic Research) and Zhong Guo Wei Sheng Jing Ji (Chinese Health Economics), and 5 book chapters. He has participated in about 20 research projects, such as A Design of Framework for Healthcare Reform in China which is commissioned by the State Council Working Party on Health Reform, Strategy Planning Study of "Healthy China 2020" which is commissioned by the Minister of Health, and Health Challenge in the Aging Society and It's Policy Implication funded by Chinese National Natural Science Foundation.

Chen earned his Ph.D. in Economics from Peking University in 2010, and earned a B.A. in Business Administration from Nanjing University in 2001. From 2004 through 2008, he was Executive Assistant of the Director of the China Centre for Economic Research at Peking University (CCER). He is also a postdoctoral fellow of National School of Development at Peking University (Its predecessor is CCER).

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Columbia University, MSPH
Dept. of Health Policy & Mgmt.
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New York, NY 10032

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Professor, Department of Health Policy and Management, Joseph Mailman School of Public Health, Columbia University
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Dr. John Rowe is the Julius B. Richmond Professor of Health Policy and Aging at the Columbia University Mailman School of Public Health.  Previously, from 2000 until his retirement in late 2006, Dr. Rowe served as Chairman and CEO of Aetna, Inc., one of the nation's leading health care and related benefits organizations.  Before his tenure at Aetna, from 1998 to 2000, Dr. Rowe served as President and Chief Executive Officer of Mount Sinai NYU Health, one of the nation’s largest academic health care organizations. From 1988 to 1998, prior to the Mount Sinai-NYU Health merger, Dr. Rowe was President of the Mount Sinai Hospital and the Mount Sinai School of Medicine in New York City.

Before joining Mount Sinai, Dr. Rowe was a Professor of Medicine and the founding Director of the Division on Aging at the Harvard Medical School, as well as Chief of Gerontology at Boston’s Beth Israel Hospital.  He was Director of the MacArthur Foundation Research Network on Successful Aging and is co-author, with Robert Kahn, Ph.D., of Successful Aging (Pantheon, 1998). Currently, Dr. Rowe leads the MacArthur Foundation’s Network on An Aging Society .

Dr. Rowe was elected a Fellow of the American Academy of Arts and Sciences and a member of the Institute of Medicine of the National Academy of Sciences. He  serves on the Board of Trustees of the Rockefeller Foundation and is Chairman of the Board of Trustees at the Marine Biological Laboratory in Woods Hole, Massachusetts and the Board of Overseers of Columbia University’s Mailman School of Public Health. He is Chair of the Advisory Council of Stanford University’s Center on Longevity, and  was a founding Commissioner of the Medicare Payment Advisory Commission ( Medpac) and Chair of the board of Trustees of the University of Connecticut. 

Adjunct Affiliate at the Center for Health Policy and the Department of Health Policy
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Abstract

CONTEXT:

Most smokers with mental illness do not receive tobacco cessation treatment.

OBJECTIVE:

To determine whether integrating smoking cessation treatment into mental health care for veterans with posttraumatic stress disorder (PTSD) improves long-term smoking abstinence rates.

DESIGN, SETTING, AND PATIENTS:

A randomized controlled trial of 943 smokers with military-related PTSD who were recruited from outpatient PTSD clinics at 10 Veterans Affairs medical centers and followed up for 18 to 48 months between November 2004 and July 2009.

INTERVENTION:

Smoking cessation treatment integrated within mental health care for PTSD delivered by mental health clinicians (integrated care [IC]) vs referral to Veterans Affairs smoking cessation clinics (SCC). Patients received smoking cessation treatment within 3 months of study enrollment.

MAIN OUTCOME MEASURES:

Smoking outcomes included 12-month bioverified prolonged abstinence (primary outcome) and 7- and 30-day point prevalence abstinence assessed at 3-month intervals. Amount of smoking cessation medications and counseling sessions delivered were tested as mediators of outcome. Posttraumatic stress disorder and depression were repeatedly assessed using the PTSD Checklist and Patient Health Questionnaire 9, respectively, to determine if IC participation or quitting smoking worsened psychiatric status.

RESULTS:

Integrated care was better than SCC on prolonged abstinence (8.9% vs 4.5%; adjusted odds ratio, 2.26; 95% confidence interval [CI], 1.30-3.91; P = .004). Differences between IC vs SCC were largest at 6 months for 7-day point prevalence abstinence (78/472 [16.5%] vs 34/471 [7.2%], P < .001) and remained significant at 18 months (86/472 [18.2%] vs 51/471 [10.8%], P < .001). Number of counseling sessions received and days of cessation medication used explained 39.1% of the treatment effect. Between baseline and 18 months, psychiatric status did not differ between treatment conditions. Posttraumatic stress disorder symptoms for quitters and nonquitters improved. Nonquitters worsened slightly on the Patient Health Questionnaire 9 relative to quitters (differences ranged between 0.4 and 2.1, P = .03), whose scores did not change over time.

CONCLUSION:

Among smokers with military-related PTSD, integrating smoking cessation treatment into mental health care compared with referral to specialized cessation treatment resulted in greater prolonged abstinence.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT00118534.

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JAMA
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Mark W. Smith
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Chronic viral diseases such as human immunodeficiency virus (HIV) and hepatitis B virus (HBV) afflict millions of people worldwide. A key public health challenge in managing such diseases is identifying infected, asymptomatic individuals so that they can receive antiviral treatment. Such treatment can benefit both the treated individual (by improving quality and length of life) and the population as a whole (through reduced transmission). We develop a compartmental model of a chronic, treatable infectious disease and use it to evaluate the cost and effectiveness of different levels of screening and contact tracing.

We show that:

  1. the optimal strategy is to get infected individuals into treatment at the maximal rate until the incremental health benefits balance the incremental cost of controlling the disease;
  2. as one reduces the disease prevalence by moving people into treatment (which decreases the chance that they will infect others), one should increase the level of contact tracing to compensate for the decreased effectiveness of screening;
  3. as the disease becomes less prevalent, it is optimal to spend more per case identified; and
  4. the relative mix of screening and contact tracing at any level of disease prevalence is such that the marginal efficiency of contact tracing (cost per infected person found) equals that of screening if possible (e.g., when capacity limitations are not binding).

We also show how to determine the costeffective equilibrium level of disease prevalence (among untreated individuals), and we develop an approximation of the path of the optimal prevalence over time. Using this, one can obtain a close approximation of the optimal solution without having to solve an optimal control problem. We apply our methods to an example of hepatitis B virus.

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Mathematical Biosciences
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Kirk R. Smith will speak about his current research on health-damaging and climate-changing air pollution from household energy use in developing Asia, including field measurement and health-effects studies in India, China, and Nepal, compared to other countries such as Mexico and Guatemala. The work encompasses developing and deploying small, smart, and cheap microchip-based monitors as well as tools for international policy assessments.

Dr. Smith is Professor of Global Environmental Health and Director of the Global Health and Environment Program at the School of Public Health at the University of California, Berkeley.  Previously, he was founder and head of the Energy Program of the East-West Center in Honolulu, where he still holds appointment as Adjunct Senior Fellow in Environment and Health after moving to Berkeley in 1995. He serves on a number of national and international scientific advisory committees including the Global Energy Assessment, National Research Council's Board on Atmospheric Science and Climate, the Executive Committee for WHO Air Quality Guidelines, and the International Comparative Risk Assessment. He participated along with many other scientists in the IPCC's 3rd and 4th assessments and thus shared the 2007 Nobel Peace Prize. He holds visiting professorships in India and China and bachelors, masters, and doctoral degrees from UC Berkeley. In 1997, he was elected a member of the US National Academy of Sciences. In 2009, he received the Heinz Prize in Environment.

Daniel and Nancy Okimoto Conference Room

Kirk R. Smith Professor of Global Environmental Health and Director of the Global Health and Environment Program at the School of Public Health Speaker University of California, Berkeley
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Objective To determine the association of reductions in price of antiretroviral drugs and foreign assistance for HIV with coverage of antiretroviral treatment.

Design Retrospective study.

Setting Africa.

Participants 13 African countries, 2003-8.

Main outcome measures A price index of first line antiretroviral therapy with data on foreign assistance for HIV was used to estimate the associations of prices and foreign assistance with antiretroviral coverage (percentage of people with advanced HIV infection receiving antiretroviral therapy), controlling for national public health spending, HIV prevalence, governance, and fixed effects for countries and years.

Results Between 2003 and 2008 the annual price of first line antiretroviral therapy decreased from $1177 (£733; €844) to $96 and foreign assistance for HIV per capita increased from $0.4 to $13.8. At an annual price of $100, a $10 decrease was associated with a 0.16% adjusted increase in coverage (95% confidence interval 0.11% to 0.20%; 0.19% unadjusted, 0.14% to 0.24%). Each additional $1 per capita in foreign assistance for HIV was associated with a 1.0% adjusted increase in coverage (0.7% to 1.2%; 1.4% unadjusted, 1.1% to 1.6%). If the annual price of antiretroviral therapy stayed at $100, foreign assistance would need to quadruple to $64 per capita to be associated with universal coverage. Government effectiveness and national public health expenditures were also positively associated with increasing coverage.

Conclusions Reductions in price of antiretroviral drugs were important in broadening coverage of HIV treatment in Africa from 2003 to 2008, but their future role may be limited. Foreign assistance and national public health expenditures for HIV seem more important in expanding future coverage.

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BMJ
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Eran Bendavid
Grant Miller
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What has the United States accomplished with its unprecedented build-up of immigration enforcement along the U.S.-Mexico border and in the interior of the country since 1993? How has this effort shaped the migration projects of Mexicans?  From the standpoint of U.S. policymakers, what has “worked,” what has not, and why?  In explaining major changes in migration flows since 2007, which matters most: U.S. border enforcement or the Great Recession?  In addressing these questions, Professor Cornelius will draw upon extensive fieldwork conducted in 2010 in rural Jalisco, the San Francisco Bay area, and Oklahoma City, as well as a new analysis of survey data from UCSD’s Mexican Migration Field Research and Training Program covering 2007-2010.

Wayne A. Cornelius is Co-Director, Education Programs, of the University of California’s Global Health Institute (UCGHI); Associate Director, UC Center of Expertise on Migration and Health; and a Core Faculty Member, Division of Global Public Health, School of Medicine, University of California-San Diego. He is Director Emeritus of the UCSD Center for Comparative Immigration Studies; Distinguished Professor of Political Science, Emeritus; and Theodore E. Gildred Professor of U.S.-Mexican Relations at UCSD. He is a past President of the Latin American Studies Association and an elected member of the Council on Foreign Relations (New York). One of the world's foremost experts on Mexican migration to the United States, comparative immigration policy, international migration and health, and the Mexican political system, Cornelius conducted field research in Mexico and the United States nearly every year from 1970 to 2009.  His latest among more than 280 publications on migration is a book titled Mexican Migration and the U.S. Economic Crisis: A Transnational Perspective.

Co-sponsored by Bill Lane Center for the American West, Center for Latin American Studies (CLAS), Chicana/o Studies, Freeman Spogli Institute for International Studies, Institute on the Politics of Inequality, Race and Ethnicity at Stanford (InSPIRES), MEChA, Stanford Humanities Center and Stanford Immigrant Rights Project.

Levinthal Hall

Wayne Cornelius Co-Director, Education Programs, University of California's Global Health Institute Speaker
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Shorenstein APARC
Stanford University
Encina Hall, Room E301
Stanford, CA 94305-6055

(650) 725-2507 (650) 723-6530
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Sangho Moon is professor of Economics and Social Policy at the Department of Public Administration, Sungkyunkwan University. His research interest focuses on evaluating social policy in the context of East Asian Welfare States. He earned his Ph.D. from the University of Wisconsin-Madison and taught at the Tennessee State University. His recent papers appeared in the International Journal of Public Administration, Review of Public Policy, Journal of Health and Human Services Administration, Economic Inquiry, Economics of Education Review, Health Policy, BMC Public Health, Women's Health Issues, and Clinical Research and Regulatory Affairs. http://web.skku.edu/~smoon/

2010-2011 Visiting Scholar
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