Elissa M. Ozanne, PhD

Research Interests

  • Decision Analytic Modeling
  • Cost Effectiveness Analysis
  • Developing and Evaluating Risk Assessment and Communication Strategies
  • Developing and Evaluating Methods to Improve Patient and Provider Decision Making
  • Population Health
  • Decision Analysis

Languages

  • English

Academic Information

  • Departments: Population Health Sciences - Associate Professor
  • Divisions: Health System Innovation and Research

Academic Office Information

  • 801-213-4130
  • Williams Building
    Department of Population Health Sciences
    295 Chipeta Way, Room: Room 1S111
    Salt Lake City, UT 84108

Academic Bio

Not applicable.

Research Statement

Dr. Elissa Ozanne's primary career goal is to guide effective, patient-centered use of prevention, screening, and treatment strategies in cancer and other contexts. Her research is focused on decision-making, including the developing and testing of clinical decision aids, risk communication methods, cost-effectiveness and risk modeling.

Education History

Type School Degree
Postdoctoral Training Dartmouth-Hitchcock Medical Center
Summer Institute in Informed Patient Choice
Postdoctoral Training
Postdoctoral Training Harvard Medical School
Leadership for Physicians and Scientists
Postdoctoral Training
Postdoctoral Training Massachusetts General Hospital
NCI Program in Cancer Outcomes Research Training
Postdoctoral Training
Postdoctoral Training University of California, San Francisco
Carol Franc Buck Breast Care Center
Postdoctoral Training
Doctoral Training Stanford University
Management Science and Engineering: Decision Analysis
Ph.D.
Graduate Training Stanford University
Engineering Economic Systems
M.S.
Undergraduate Stanford University
Biological Sciences
B.S.

Selected Publications

Journal Article

  1. Barr PJ, Forcino RC, Thompson R, Ozanne EM, Arend R, Castaldo MG, OMalley AJ, Elwyn G (2017). Evaluating CollaboRATE in a clinical setting: analysis of mode effects on scores, response rates and costs of data collection. BMJ Open, 7(3), e014681.
  2. Ozanne EM, Weiss JE, Onega T, DeMartini W, Kerlikowske K, Buist DS, Henderson L, Hubbard RA, Goodrich M, Tosteson AN, Virnig BA, ODonoghue C (2017). Locoregional treatment of breast cancer in women with and without preoperative magnetic resonance imaging. Am J Surg, 213(1), 132-139.e2.
  3. Punglia RS, Cronin AM, Uno H, Stout NK, Ozanne EM, Greenberg CC, Frank ES, Schrag D (2017). Association of Regional Intensity of Ductal Carcinoma In Situ Treatment With Likelihood of Breast Preservation. JAMA Oncol, 3(1), 101-104.
  4. Barnes AJ, Hanoch Y, Miron-Shatz T, Ozanne EM (2016). Tailoring risk communication to improve comprehension: Do patient preferences help or hurt? Health Psychol, 35(9), 1007-16.
  5. Cohan JN, Ozanne EM, Sewell JL, Hofer RK, Mahadevan U, Varma MG, Finlayson E (2016). A Novel Decision Aid for Surgical Patients with Ulcerative Colitis: Results of a Pilot Study. Dis Colon Rectum, 59(6), 520-8.
  6. Barlow DR, Higgins BT, Ozanne EM, Tosteson AN, Pearson AM (2016). Cost Effectiveness of Operative Versus Non-Operative Treatment of Geriatric Type-II Odontoid Fracture. Spine, 41(7), 610-7.
  7. Hanoch Y, Miron-Shatz T, Rolison JJ, Omer Z, Ozanne E (2015). Shared decision making in patients at risk of cancer: the role of domain and numeracy. Health Expect, 18(6), 2799-810.
  8. Ozanne EM, Schneider KH, Soeteman D, Stout N, Schrag D, Fordis M, Punglia RS (2015). onlineDeCISion.org: a web-based decision aid for DCIS treatment. Breast Cancer Res Treat, 154(1), 181-90.
  9. Howe R, Miron-Shatz T, Hanoch Y, Omer ZB, ODonoghue C, Ozanne EM (2015). Personalized Medicine Through SNP Testing for Breast Cancer Risk: Clinical Implementation. J Genet Couns, 24(5), 744-51.
  10. Yachimski P, Wani S, Givens T, Howard E, Higginbotham T, Price A, Berman K, Hosford L, Katcher PM, Ozanne E, Perzan K, Hur C (2015). Preference of endoscopic ablation over medical prevention of esophageal adenocarcinoma by patients with Barrett's esophagus. Clin Gastroenterol Hepatol, 13(1), 84-90.
  11. Miron-Shatz T, Hanoch Y, Katz BA, Doniger GM, Ozanne EM (2015). Willingness to test for BRCA1/2 in high risk women: Influenced by risk perception and family experience, rather than by objective or subjective numeracy? Judgm Decis Mak, 10(4), 386-99.
  12. Hanoch Y, Miron-Shatz T, Rolison JJ, Ozanne E (2014). Understanding of BRCA1/2 genetic tests results: the importance of objective and subjective numeracy. Psychooncology, 23(10), 1142-8.
  13. Fehniger J, Livaudais-Toman J, Karliner L, Kerlikowske K, Tice JA, Quinn J, Ozanne E, Kaplan CP (2014). Perceived versus objective breast cancer risk in diverse women. J Womens Health (Larchmt), 23(5), 420-7.
  14. Esserman LJ, Alvarado MD, Howe RJ, Mohan AJ, Harrison B, Park C, ODonoghue C, Ozanne EM (2014). Application of a decision analytic framework for adoption of clinical trial results: are the data regarding TARGIT-A IORT ready for prime time? Breast Cancer Res Treat, 144(2), 371-8.
  15. ODonoghue C, Eklund M, Ozanne EM, Esserman LJ (2014). Aggregate cost of mammography screening in the United States: comparison of current practice and advocated guidelines. Ann Intern Med, 160(3), 145.
  16. Ozanne EM, Howe R, Omer Z, Esserman LJ (2014). Development of a personalized decision aid for breast cancer risk reduction and management. BMC Med Informat Decis Making, 14, 4.
  17. Barr PJ, Thompson R, Walsh T, Grande SW, Ozanne EM, Elwyn G (2014). The psychometric properties of CollaboRATE: a fast and frugal patient-reported measure of the shared decision-making process. J Med Internet Res, 16(1), e2.
  18. Bravo C, ODonoghue C, Kaplan CP, Luce J, Ozanne E (2014). Can mHealth Improve Risk Assessment in Underserved Populations? Acceptability of a Breast Health Questionnaire App in Ethnically Diverse, Older, Low-Income Women.LID - 6 [pii]. J Health Dispar Res Pract, 7(4).
  19. Miron-Shatz T, Hanoch Y, Doniger GM, Omer ZB, Ozanne EM (2014). Subjective but not objective numeracy influences willingness to pay for BRCA1/2 genetic testing among women. Judgm Decis Mak, 9(2), 152-8.
  20. Alvarado MD, Conolly J, Park C, Sakata T, Mohan AJ, Harrison BL, Hayes M, Esserman LJ, Ozanne EM (2014). Patient preferences regarding intraoperative versus external beam radiotherapy following breast-conserving surgery. Breast Cancer Res Treat, 143(1), 135-40.
  21. Omer ZB, Hwang ES, Esserman LJ, Howe R, Ozanne EM (2013). Impact of ductal carcinoma in situ terminology on patient treatment preferences. JAMA Intern Med, 173(19), 1830-1.
  22. Elwyn G, Barr PJ, Grande SW, Thompson R, Walsh T, Ozanne EM (2013). Developing CollaboRATE: a fast and frugal patient-reported measure of shared decision making in clinical encounters. Patient Educ Couns, 93(1), 102-7.
  23. Alvarado MD, Mohan AJ, Esserman LJ, Park CC, Harrison BL, Howe RJ, Thorsen C, Ozanne EM (2013). Cost-effectiveness analysis of intraoperative radiation therapy for early-stage breast cancer. Ann Surg Oncol, 20(9), 2873-80.
  24. Soeteman DI, Stout NK, Ozanne EM, Greenberg C, Hassett MJ, Schrag D, Punglia RS (2013). Modeling the effectiveness of initial management strategies for ductal carcinoma in situ. J Natl Cancer Inst, 105(11), 774-81.
  25. Ozanne EM, Drohan B, Bosinoff P, Semine A, Jellinek M, Cronin C, Millham F, Dowd D, Rourke T, Block C, Hughes KS (2013). Which risk model to use? Clinical implications of the ACS MRI screening guidelines. Cancer Epidemiol Biomarkers Prev, 22(1), 146-9.
  26. Esserman L, Ozanne E, vant Veer L (2013). Will early detection for breast cancer ever work? Clin Chem, 59(1), 190-3.
  27. Ozanne EM (2013). Overdiagnosis and Overtreatment of Breast Cancer: How Can We Promote Informed Patient Choice? Curr Breast Cancer Rep, 5(4), 263-5.
  28. Ozanne EM, OConnell A, Bouzan C, Bosinoff P, Rourke T, Dowd D, Drohan B, Millham F, Griffin P, Halpern EF, Semine A, Hughes KS (2012). Bias in the reporting of family history: implications for clinical care. J Genet Couns, 21(4), 547-56.
  29. Lowry KP, Lee JM, Kong CY, McMahon PM, Gilmore ME, Cott Chubiz JE, Pisano ED, Gatsonis C, Ryan PD, Ozanne EM, Gazelle GS (2012). Annual screening strategies in BRCA1 and BRCA2 gene mutation carriers: a comparative effectiveness analysis. Cancer, 118(8), 2021-30.
  30. Alvarado M, Ozanne E, Esserman L (2012). Overdiagnosis and overtreatment of breast cancer. Am Soc Clin Oncol Educ Book, e40-5.
  31. Campbell S, Stowe K, Ozanne EM (2011). Interprofessional practice and decision support: an organizational framework applied to a mental health setting. J Interprof Care, 25(6), 423-7.
  32. Esserman LJ, Moore DH, Tsing PJ, Chu PW, Yau C, Ozanne E, Chung RE, Tandon VJ, Park JW, Baehner FL, Kreps S, Tutt AN, Gillett CE, Benz CC (2011). Biologic markers determine both the risk and the timing of recurrence in breast cancer. Breast Cancer Res Treat, 129(2), 607-16.
  33. Ozanne EM, Shieh Y, Barnes J, Bouzan C, Hwang ES, Esserman LJ (2011). Characterizing the impact of 25 years of DCIS treatment. Breast Cancer Res Treat, 129(1), 165-73.
  34. Lee JM, McMahon PM, Kong CY, Kopans DB, Ryan PD, Ozanne EM, Halpern EF, Gazelle GS (2010). Cost-effectiveness of breast MR imaging and screen-film mammography for screening BRCA1 gene mutation carriers. Radiology, 254(3), 793-800.
  35. Ozanne EM, Wittenberg E, Garber JE, Weeks JC (2010). Breast cancer prevention: patient decision making and risk communication in the high risk setting. Breast J, 16(1), 38-47.
  36. Hur C, Broughton DE, Kong CY, Ozanne EM, Richards EB, Truong T, Gazelle GS (2009). Patient preferences for the chemoprevention of colorectal cancer. Dig Dis Sci, 54(10), 2207-14.
  37. Drohan B, Ozanne EM, Hughes KS (2009). Electronic health records and the management of women at high risk of hereditary breast and ovarian cancer. Breast J, 15 Suppl 1, S46-55.
  38. Sepucha KR, Ozanne EM, Partridge AH, Moy B (2009). Is there a role for decision aids in advanced breast cancer? Med Decis Making, 29(4), 475-82.
  39. Ozanne EM, Partridge A, Moy B, Ellis KJ, Sepucha KR (2009). Doctor-patient communication about advance directives in metastatic breast cancer. J Palliat Med, 12(6), 547-53.
  40. Braithwaite D, Tammemagi CM, Moore DH, Ozanne EM, Hiatt RA, Belkora J, West DW, Satariano WA, Liebman M, Esserman L (2009). Hypertension is an independent predictor of survival disparity between African-American and white breast cancer patients. Int J Cancer, 124(5), 1213-9.
  41. Ozanne EM, Loberg A, Hughes S, Lawrence C, Drohan B, Semine A, Jellinek M, Cronin C, Milham F, Dowd D, Block C, Lockhart D, Sharko J, Grinstein G, Hughes KS (2009). Identification and management of women at high risk for hereditary breast/ovarian cancer syndrome. Breast J, 15(2), 155-62.
  42. Ozanne EM, Braithwaite D, Sepucha K, Moore D, Esserman L, Belkora J (2009). Sensitivity to input variability of the Adjuvant! Online breast cancer prognostic model. J Clin Oncol, 27(2), 214-9.
  43. Ozanne EM, Drohan B, Hughes KS (2009). Challenges and Improvements in the Identification of Women at High Risk. Breast Dis Year Bk Q, 20(3), 248-50.
  44. Pandharipande PV, Harisinghani MG, Ozanne EM, Specht MC, Hur C, Lee JM, Gazelle GS (2008). Staging MR lymphangiography of the axilla for early breast cancer: cost-effectiveness analysis. AJR Am J Roentgenol, 191(5), 1308-19.
  45. Hur C, Broughton DE, Ozanne E, Yachimski P, Nishioka NS, Gazelle GS (2008). Patient preferences for the chemoprevention of esophageal adenocarcinoma in Barrett's esophagus. Am J Gastroenterol, 103(10), 2432-42.
  46. Silvia KA, Ozanne EM, Sepucha KR (2008). Implementing breast cancer decision aids in community sites: barriers and resources. Health Expect, 11(1), 46-53.
  47. Ozanne EM, Annis C, Adduci K, Showstack J, Esserman L (2007). Pilot trial of a computerized decision aid for breast cancer prevention. Breast J, 13(2), 147-54.
  48. Sepucha K, Ozanne E, Silvia K, Partridge A, Mulley AG Jr (2007). An approach to measuring the quality of breast cancer decisions. Patient Educ Couns, 65(2), 261-9.
  49. Sepucha K, Ozanne E, Mulley AG Jr (2006). Doing the right thing: systems support for decision quality in cancer care. Ann Behav Med, 32(3), 172-8.
  50. Ozanne EM, Klemp JR, Esserman LJ (2006). Breast cancer risk assessment and prevention: a framework for shared decision-making consultations. Breast J, 12(2), 103-13.
  51. Esserman LJ, Ozanne EM, Dowsett M, Slingerland JM (2005). Tamoxifen may prevent both ER+ and ER- breast cancers and select for ER- carcinogenesis: an alternative hypothesis. Breast Cancer Res, 7(6), R1153-8.
  52. Ozanne EM, Esserman LJ (2004). Evaluation of breast cancer risk assessment techniques: a cost-effectiveness analysis. Cancer Epidemiol Biomarkers Prev, 13(12), 2043-52.
  53. Esserman L, Sepucha K, Ozanne E, Hwang ES (2004). Applying the neoadjuvant paradigm to ductal carcinoma in situ. Ann Surg Oncol, 11(1 Suppl), 28S-36S.
  54. Holtzman S, Ozanne E, Carone B, Goldstein MK, Steinke G, Timbs J (1999). Decision analysis and Alzheimer disease: three case studies. Genet Test, 3(1), 71-83.

Review

  1. Winn K, Ozanne E, Sepucha K (2015). Measuring patient-centered care: An updated systematic review of how studies define and report concordance between patients' preferences and medical treatments. [Review]. Patient Educ Couns, 98(7), 811-21.
  2. Walsh T, Barr PJ, Thompson R, Ozanne E, ONeill C, Elwyn G (2014). Undetermined impact of patient decision support interventions on healthcare costs and savings: systematic review. [Review]. BMJ, 348, g188.
  3. Trevena LJ, Zikmund-Fisher BJ, Edwards A, Gaissmaier W, Galesic M, Han PK, King J, Lawson ML, Linder SK, Lipkus I, Ozanne E, Peters E, Timmermans D, Woloshin S (2013). Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers. [Review]. BMC Med Informat Decis Making, 13 Suppl 2, S7.
  4. Abhyankar P, Volk RJ, Blumenthal-Barby J, Bravo P, Buchholz A, Ozanne E, Vidal DC, Col N, Stalmeier P (2013). Balancing the presentation of information and options in patient decision aids: an updated review. [Review]. BMC Med Informat Decis Making, 13 Suppl 2, S6.
  5. Sepucha K, Ozanne EM (2010). How to define and measure concordance between patients' preferences and medical treatments: A systematic review of approaches and recommendations for standardization. [Review]. Patient Educ Couns, 78(1), 12-23.
  6. Esserman LJ, Shieh Y, Park JW, Ozanne EM (2007). A role for biomarkers in the screening and diagnosis of breast cancer in younger women. [Review]. Expert Rev Mol Diagn, 7(5), 533-44.

Book Chapter

  1. Ozanne EM, Esserman L (2010). Decision Making in Breast Cancer Prevention. In Psicooncología (7, pp. 299-311).

Letter

  1. Ozanne EM, Hwang ES, Esserman LJ (2007). Letter to the Editor [Letter to the editor]. Breast J, 13(5), 540.

Abstract

  1. Ozanne EM, Stout N, Schneider K, Soeteman D, Schrag D, Fordis M, Punglia R (2015). onlineDeCISion.org: An interactive web-based clinical decision aid for DCIS treatment; also presented as a poster at the 37th Annual CTRC-AACR San Antonio Breast Cancer Symposium; December 9-13, 2014; San Antonio, TX [Abstract]. Cancer Res, 75(9 Suppl), P2-10-01.
  2. Alvarado MD, Hayes MT, Sethi R, Ozanne EM (2015). NSABP B-43 is unlikely to produce a cost-effective treatment strategy for HER2+ DCIS [Abstract]. Cancer Res, 75(9 Suppl), P1-10-03.
  3. Thompson C, Ekland M, ODonoghue C, Ozanne EM, Esserman L (2015). The aggregate number of false-positive recalls and biopsies performed under different breast cancer screening strategies in the US; also presented as a poster at the 37th Annual CTRC-AACR San Antonio Breast Cancer Symposium; December 9-13, 2014; San Antonio, TX [Abstract]. Cancer Res, 75(9 Suppl), P3-02-01.
  4. Henderson L, Hubbard R, Wernli K, Kerlikowske K, Buist DSM, Sprague B, Goodrich M, DeMartini W, Ozanne E, Zhu W, ODonoghue C, Virnig BA, Tosteson ANA, Onega T (2015). Are breast density and family history associated with pre-operative breast MRI use? [Abstract]. J Clin Oncol, 33(15 Suppl), e17543.
  5. Ozanne EM, Drohan B, Hughes KS (2013). Breast cancer risk assessment: How risk models can “overdiagnose” risk; also presented at the American Society of Clinical Oncology Annual Meeting Quality Care Symposium; November 1-2, 2013 [Abstract]. Journal of Clinical Oncology, 31(31 Suppl), 184.
  6. Thorsen CM, Weiss JE, Kerlikowske K, Ozanne EM, Buist DS, Hubbard RA, Tosteson AN, Henderson LM, Virnig BA, Goodrich ME, Onega TL (2012). Impact of preoperative MRI on the surgical treatment of breast cancer: a SEER-Medicare analysis [Abstract]. Cancer Res, 72(24 Suppl), P4-01-15.
  7. Howe R, Omer Z, Hanoch Y, Miron-Shatz T, Thorsen C, Ozanne EM (2012). Single nucleotide polymorphism testing for breast cancer risk assessment: Patient trust and willingness to pay [Abstract]. Cancer Res, 72(24 Suppl), P4-11-03.
  8. Alvarado M, Harrison B, Howe R, Rounds K, Solin L, Ozanne EM (2012). Cost-effectiveness of gene expression profiling for ductal carcinoma in-situ (Oncotype DCIS Score) [Abstract]. Cancer Res, 72(24 Suppl), P5-15-01.
  9. Thorsen CM, Eklund M, Ozanne EM, Esserman LJ (2012). The cost of mammography screening in the United States by screening policy [Abstract]. Cancer Res, 72(24 Suppl), P3-02-12.
  10. Ozanne EM, Crawford B, Petruse A, Madlensky L, Weiss L, Hogarth M, Wenger N, Goodman D, Park H, Anton-Culver H, Yasmeen S, Howell L, Ojeda H, Parker B, Kaplan C, vant Veer L, Esserman L, Naeim A (2012). Risk assessment and personalized decision support: The University of California Athena Breast Health Network; also presented as a poster at the 35th Annual CTRC‐AACR San Antonio Breast Cancer Symposium; Dec 4‐8, 2012; San Antonio, TX [Abstract]. Cancer Res, 72(24 Suppl), P4-13-13.
  11. Howe R, Hassett M, Wheelock A, ODonoghue CT, Kaplan C, Ozanne EM (2012). Cost of cancer care: The impact of disclosure on treatment preferences [Abstract]. J Clin Oncol, 30(Suppl 34), 15.
  12. Omer Z, Hwang ES, Esserman L, Ozanne EM (2011). Words matter: Influence of DCIS diagnosis terminology on patient treatment decisions [Abstract]. Cancer Res, 71(24 Suppl), P5-15-01.
  13. Ozanne EM, Omer Z, Carlson K (2011). Automated breast cancer risk assessment: Identifying high risk women in the primary care setting; also presented as a poster at the 34th Annual CTRC‐AACR San Antonio Breast Cancer Symposium; Dec 6‐10, 2011; San Antonio, TX [Abstract]. Cancer Res, 71(24 Suppl), P4-10-04.
  14. Esserman LJ, Mohan AJ, Park C, Berry D, Ozanne EM, Alvarado MD (2011). Projecting the impact of adopting trial results [Abstract]. Cancer Res, 71(24 Suppl), PD06-08.
  15. Alvarado M, Mohan A, Esserman LJ, Ozanne EM (2011). Cost-effectiveness of intraoperative radiation therapy for breast conservation [Abstract]. J Clin Oncol, 29(15 Suppl), 6081.
  16. Ozanne EM, Boortz S, Bechtold T, Esserman LJ (2010). Wide Scale, Automated Breast Cancer Risk Assessment and Decision Support for High Risk Women: www.BreastHealthDecisions.org; also presented as a poster at the 33rd Annual CTRC‐AACR San Antonio Breast Cancer Symposium; Dec 8‐12, 2010; San Antonio, TX [Abstract]. Cancer Res, 70(24 Suppl), P6-09-11.
  17. Esserman E, Chu B, Chung R, Ozanne EM, Yau C, Tsing P, Baehner FL, Tutt AN, Moore DH, Benz C (2010). Risk partitioning model shows need to address time dependence of breast cancer recurrence™ [Abstract]. J Clin Oncol, 28(15 Suppl), 10605.
  18. Ozanne EM, Cipriano L, Cameron M, Newman T, Esserman LJ (2009). Cost-effectiveness of surgical interventions for BRCA gene mutation carriers: impact of delaying decision-making; also presented as a poster at the 2008 CTRC-AACR San Antonio Breast Cancer Symposium [Abstract]. Cancer Res, 69(2 Suppl), 503.
  19. Ozanne EM, Sharko J, Drohan B, Grinstein G, Hughes KS (2009). Identification of high-risk lesions through automated natural language processing (NLP) of pathology reports; also presented as a poster at the 2008 CTRC-AACR San Antonio Breast Cancer Symposium [Abstract]. Cancer Res, 69(2 Suppl), 3001.
  20. Ozanne EM, Cipriano L, Cameron M, Newman T, Esserman LJ (2009). Cost-effectiveness of genetic testing for BRCA1 and BRCA2 mutations; also presented as a poster at the 2008 CTRC-AACR San Antonio Breast Cancer Symposium [Abstract]. Cancer Res, 69(2 Suppl), 6100.
  21. Braithwaite D, Moore D, Liebman M, Belkora J, West D, Satariano W, Ozanne EM, Esserman (2006). New comorbidity model to optimize decisions about interventions for breast cancer patients [Abstract]. Breast Cancer Res Treat, 100(Suppl 1).
  22. Braithwaite D, Moore D, West D, Satariano W, Liebman M, Belkora J, Ozanne EM, Esserman L (2005). Estimating prognostic impact of comorbidity: Development of a breast cancer specific model [Abstract]. Breast Cancer Res Treat, 94(Suppl 1).
  23. Ozanne EM, Esserman L (2003). A new breast cancer prevention tool incorporates contextual risk assessment and biomarkers [Abstract]. J Clin Oncol.
  24. Ozanne EM, Esserman L (2001). Risk Assessment Guidelines for Breast Cancer Prevention Used in a Shared Medical Decision Making Setting; also presented orally at the 23rd Annual Meeting of the Society for Medical Decision Making [Abstract]. Med Decis Making, 21(6).

Other

  1. Ozanne EM (2003). An analytic approach to medical risk management: Decisions for breast cancer prevention. (Thesis). Stanford, CA: Stanford University.