A groundbreaking look at the future of great power competition in an age of globalization and what the United States can do in response The two decades after the Cold War saw unprecedented cooperation between the major powers as the world converged on a model of liberal international order. Now, great power competition is back and the liberal order is in jeopardy. Russia and China are increasingly revisionist in their regions. The Middle East appears to be unraveling. And many Americans question why the United States ought to lead. What will great power competition look like in the decades ahead? Will the liberal world order survive? What impact will geopolitics have on globalization? And, what strategy should the United States pursue to succeed in an increasingly competitive world? In this book Thomas Wright explains how major powers will compete fiercely even as they try to avoid war with each other. Wright outlines a new American strategy—Responsible Competition—to navigate these challenges and strengthen the liberal order.

Health literacy-the ability for individuals to obtain, process, and understand basic health information and services to facilitate appropriate health decisions-is increasingly recognized as an important facet of health care and health outcomes. Although research on health literacy has grown tremendously in the past decade, there is no widely agreed-upon framework for health literacy as a determinant of health outcomes. Most instruments focus on assessing an individual's health literacy, yet the scope of health literacy reaches far beyond an individual's skills and abilities. Health literacy occurs in the context of the health care system, and therefore measures of health literacy must also assess the demands and complexities of the health care systems with which patients interact. For example, measures are needed to determine how well the system has been organized so that it can be navigated by individuals with different levels of health literacy and how well health organizations are doing at making health information understandable and actionable. To examine what is known about measures of health literacy, the Institute of Medicine convened a workshop. The workshop, summarized in this volume, reviews the current status of measures of health literacy, including those used in the health care setting; discusses possible surrogate measures that might be used to assess health literacy; and explores ways in which health literacy measures can be used to assess patient-centered approaches to care.

Patient-reported outcomes (PROs) are measures of how patients feel or what they are able to do in the context of their health status; PROs are reports, usually on questionnaires, about a patient's health conditions, health behaviors, or experiences with health care that individuals report directly, without modification of responses by clinicians or others; thus, they directly reflect the voice of the patient. PROs cover domains such as physical health, mental and emotional health, functioning, symptoms and symptom burden, and health behaviors. They are relevant for many activities: helping patients and their clinicians make informed decisions about health care, monitoring the progress of care, setting policies for coverage and reimbursement of health services, improving the quality of health care services, and tracking or reporting on the performance of health care delivery organizations. We address the major methodological issues related to choosing, administering, and using PROs for these purposes, particularly in clinical practice settings. We include a framework for best practices in selecting PROs, focusing on choosing appropriate methods and modes for administering PRO measures to accommodate patients with diverse linguistic, cultural, educational, and functional skills, understanding measures developed through both classic and modern test theory, and addressing complex issues relating to scoring and analyzing PRO data.

Clearly reviews the properties of important contemporary measures of association and correlation. Liebetrau devotes full chapters to measures for nominal, ordinal, and continuous (interval) data, paying special attention to the sampling distributions needed to determine levels of significance and confidence intervals. Valuable discussions also focus on the relationships between various measures, the sampling properties of their estimators and the comparative advantages and disadvantages of different approaches.